Provider Demographics
NPI:1033410873
Name:THATCHER, JACKIE RENEE (OTR)
Entity Type:Individual
Prefix:MS
First Name:JACKIE
Middle Name:RENEE
Last Name:THATCHER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 MAPLE WAY
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-5228
Mailing Address - Country:US
Mailing Address - Phone:888-873-4221
Mailing Address - Fax:888-543-2289
Practice Address - Street 1:4735 MAPLE WAY
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-5228
Practice Address - Country:US
Practice Address - Phone:307-635-7605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTR-040225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist