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NPI Code Detail

MEDICARE: DANIELLE FONTENOT OT

MEDICARE: DANIELLE FONTENOT OT
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
1225X00000XOccupational Therapist1630WY

General Provider Information

NPI Number : 1740928233
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIELLE FONTENOT OT
Provider Business Mailing Address
First Line : 4140 CENTENNIAL HILLS BLVD STE B
Second Line :
City : CASPER
State : WY
Zip : 82609-3265
Country : US
Telephone Number : 307-472-8871
Fax Number :
Provider Business Practice Location Address
First Line : 4070 PLAZA DR STE 107
Second Line :
City : CASPER
State : WY
Zip : 82604-4296
Country : US
Telephone Number : 307-337-3204
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2022
Last Update Date : 05/24/2022

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Directions to “ DANIELLE FONTENOT OT” Practice Location

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