Provider Demographics
NPI:1487836649
Name:HERBIG, GENAE ELISE (MSOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:GENAE
Middle Name:ELISE
Last Name:HERBIG
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:MS
Other - First Name:GENAE
Other - Middle Name:ELISE
Other - Last Name:NANNEMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOTR/L
Mailing Address - Street 1:PO BOX 1569
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82602-1569
Mailing Address - Country:US
Mailing Address - Phone:307-315-6184
Mailing Address - Fax:307-315-6185
Practice Address - Street 1:107 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2736
Practice Address - Country:US
Practice Address - Phone:307-315-6184
Practice Address - Fax:307-315-6185
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTR 683225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist