MEDICARE: MRS. GENAE ELISE HERBIG M.S.O.T.R./L.

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	225X00000X	Occupational Therapist	OTR 683	WY

General Provider Information

NPI Number	:	1487836649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GENAE ELISE HERBIG M.S.O.T.R./L.

Provider Business Mailing Address
First Line	:	PO BOX 1569
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82602-1569
Country	:	US
Telephone Number	:	307-315-6184
Fax Number	:	307-315-6185

Provider Business Practice Location Address
First Line	:	107 N WASHINGTON ST
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-2736
Country	:	US
Telephone Number	:	307-315-6184
Fax Number	:	307-315-6185

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

Provider Enumeration Date	:	11/29/2007
Last Update Date	:	10/17/2011

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