Provider Demographics
NPI:1689600892
Name:PICKARD, LANAE DEANN (OTR/L,CHT)
Entity Type:Individual
Prefix:
First Name:LANAE
Middle Name:DEANN
Last Name:PICKARD
Suffix:
Gender:F
Credentials:OTR/L,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 S DURBIN ST
Mailing Address - Street 2:STE 104
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2829
Mailing Address - Country:US
Mailing Address - Phone:307-472-5622
Mailing Address - Fax:307-472-5626
Practice Address - Street 1:428 S DURBIN ST
Practice Address - Street 2:STE 104
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2829
Practice Address - Country:US
Practice Address - Phone:307-472-5622
Practice Address - Fax:307-472-5626
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY031225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY312180OtherBLUE CROSS BLUE SHIELD WY
WY536508Medicare ID - Type Unspecified