Provider Demographics
NPI:1427200781
Name:CADWELL, NICOLE E (OTR/L)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:E
Last Name:CADWELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 E 2ND ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2946
Mailing Address - Country:US
Mailing Address - Phone:307-265-4343
Mailing Address - Fax:
Practice Address - Street 1:1020 E 2ND ST
Practice Address - Street 2:STE. 100
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2946
Practice Address - Country:US
Practice Address - Phone:307-265-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOT 661225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYOT 661OtherSTATE LICENSE