Provider Demographics
NPI:1821683632
Name:GILLETTE, CHEYENNE (OT)
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CHEYENNE
Other - Middle Name:
Other - Last Name:PALU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:235 S MAIN ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-1895
Mailing Address - Country:US
Mailing Address - Phone:307-278-0256
Mailing Address - Fax:
Practice Address - Street 1:235 S MAIN ST UNIT B
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-1895
Practice Address - Country:US
Practice Address - Phone:307-278-0256
Practice Address - Fax:307-278-0256
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOT-1545LL225X00000X
WYOT-1545225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist