Provider Demographics
NPI:1881004257
Name:ANTHONY, JOELLE
Entity Type:Individual
Prefix:
First Name:JOELLE
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:
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:SUITE 201
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2946
Mailing Address - Country:US
Mailing Address - Phone:307-577-8832
Mailing Address - Fax:307-237-5421
Practice Address - Street 1:1020 E 2ND ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2946
Practice Address - Country:US
Practice Address - Phone:307-577-8832
Practice Address - Fax:307-237-5421
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTR 198225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYOTR 198OtherWYOMING STATE LICENSE NUMBER