Provider Demographics
NPI:1346302023
Name:WILMES, FLOYD DALE II (OTRL)
Entity Type:Individual
Prefix:MR
First Name:FLOYD
Middle Name:DALE
Last Name:WILMES
Suffix:II
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 CHAMBERLAIN RD
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-2737
Mailing Address - Country:US
Mailing Address - Phone:307-234-8049
Mailing Address - Fax:
Practice Address - Street 1:1625 CHAMBERLAIN RD
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-2737
Practice Address - Country:US
Practice Address - Phone:307-234-8049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTR-130225X00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY112990200Medicaid