Provider Demographics
NPI:1326259227
Name:MOREY, AMANDA LYNNE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNNE
Last Name:MOREY
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 1:612 NORTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-2628
Mailing Address - Country:US
Mailing Address - Phone:307-840-6020
Mailing Address - Fax:
Practice Address - Street 1:612 NORTHVIEW DR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2628
Practice Address - Country:US
Practice Address - Phone:307-330-7812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY122219800Medicaid