Provider Demographics
NPI:1902374093
Name:SANTISTEVAN, KAROL MAE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAROL
Middle Name:MAE
Last Name:SANTISTEVAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 THIRTY THREE MILE RD
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-9584
Mailing Address - Country:US
Mailing Address - Phone:307-267-7416
Mailing Address - Fax:307-473-7827
Practice Address - Street 1:3905 TEN MILE RD
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-2894
Practice Address - Country:US
Practice Address - Phone:307-267-7416
Practice Address - Fax:949-404-6346
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOT-1381225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist