Provider Demographics
NPI:1003029653
Name:DONALD, OLIVIA L (OTRL)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:L
Last Name:DONALD
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:L
Other - Last Name:CROUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:2665 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-2045
Mailing Address - Country:US
Mailing Address - Phone:307-337-1740
Mailing Address - Fax:
Practice Address - Street 1:2665 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2045
Practice Address - Country:US
Practice Address - Phone:307-337-1740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOT-716225X00000X
WYOT716225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYOTR-716OtherSTATE LICENSE