Provider Demographics
NPI:1003578220
Name:TRIMBLE, MICHALYN
Entity Type:Individual
Prefix:
First Name:MICHALYN
Middle Name:
Last Name:TRIMBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 STAMPEDE ST
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WY
Mailing Address - Zip Code:82701-3037
Mailing Address - Country:US
Mailing Address - Phone:307-746-4560
Mailing Address - Fax:
Practice Address - Street 1:104 STAMPEDE ST
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WY
Practice Address - Zip Code:82701-3037
Practice Address - Country:US
Practice Address - Phone:307-746-4560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist