MEDICARE: TERESA D DALTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1194028100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA D DALTON

Provider Business Mailing Address
First Line	:	33 EAGLE DR
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-9664
Country	:	US
Telephone Number	:	307-763-6306
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 EAGLE DR
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-9664
Country	:	US
Telephone Number	:	307-763-6306
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2010
Last Update Date	:	12/13/2010

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Directions to “ TERESA D DALTON ” Practice Location

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