Provider Demographics
NPI:1265707798
Name:FRAILEY, MARLYN ANN (NCCSOTS)
Entity type:Individual
Prefix:MRS
First Name:MARLYN
Middle Name:ANN
Last Name:FRAILEY
Suffix:
Gender:F
Credentials:NCCSOTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1642
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82931-1642
Mailing Address - Country:US
Mailing Address - Phone:307-789-0664
Mailing Address - Fax:307-222-0614
Practice Address - Street 1:1210 BOSWELL DR
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5481
Practice Address - Country:US
Practice Address - Phone:307-760-2967
Practice Address - Fax:307-222-0614
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management