Provider Demographics
NPI:1164290235
Name:DAYTON, MARILYN (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:DAYTON
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 275
Mailing Address - Street 2:
Mailing Address - City:COKEVILLE
Mailing Address - State:WY
Mailing Address - Zip Code:83114-0275
Mailing Address - Country:US
Mailing Address - Phone:307-279-3305
Mailing Address - Fax:
Practice Address - Street 1:300 PINE STREET
Practice Address - Street 2:
Practice Address - City:COKEVILLE
Practice Address - State:WY
Practice Address - Zip Code:83114-8311
Practice Address - Country:US
Practice Address - Phone:307-279-3272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer