Provider Demographics
NPI:1598314775
Name:ANDERSON, MICHELLE LINN (OT, MOT, OTR/L, CKTP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LINN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OT, MOT, OTR/L, CKTP
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 20970
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7020
Mailing Address - Country:US
Mailing Address - Phone:307-633-7000
Mailing Address - Fax:
Practice Address - Street 1:2600 E 18TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5511
Practice Address - Country:US
Practice Address - Phone:307-633-7000
Practice Address - Fax:307-633-7075
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY988225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist