Provider Demographics
NPI:1205295623
Name:MCGINNIS-ROBINSON, JESSICA DOLORES (OTRL)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DOLORES
Last Name:MCGINNIS-ROBINSON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTRL
Mailing Address - Street 1:903 S GREELEY HWY
Mailing Address - Street 2:UNIT E
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-3057
Mailing Address - Country:US
Mailing Address - Phone:307-634-2109
Mailing Address - Fax:307-683-4005
Practice Address - Street 1:903 S GREELEY HWY
Practice Address - Street 2:UNIT E
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-3057
Practice Address - Country:US
Practice Address - Phone:307-634-2109
Practice Address - Fax:307-683-4005
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTR-1173225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist