Provider Demographics
NPI:1134533383
Name:FIORINI, GLORIA (COTA)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:FIORINI
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 E FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-3715
Mailing Address - Country:US
Mailing Address - Phone:307-840-2891
Mailing Address - Fax:
Practice Address - Street 1:1210 CANYON HILLS RD
Practice Address - Street 2:
Practice Address - City:THERMOPOLIS
Practice Address - State:WY
Practice Address - Zip Code:82443-3137
Practice Address - Country:US
Practice Address - Phone:307-864-5591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYWY 797224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant