Provider Demographics
NPI:1982631057
Name:GILMER, MICHELLE K (OTR, DPT, MSHA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:K
Last Name:GILMER
Suffix:
Gender:F
Credentials:OTR, DPT, MSHA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:K
Other - Last Name:KING-GILMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT OT
Mailing Address - Street 1:1949 SUGARLAND DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5755
Mailing Address - Country:US
Mailing Address - Phone:307-461-9891
Mailing Address - Fax:307-939-7097
Practice Address - Street 1:1949 SUGARLAND DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5755
Practice Address - Country:US
Practice Address - Phone:307-461-9891
Practice Address - Fax:307-939-7097
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10223225100000X
CO2269225X00000X
WY886225X00000X
WY1358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO305918Medicare UPIN
COC811845Medicare UPIN