Provider Demographics
NPI:1457582777
Name:CECIL, LISA EILEEN (OT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:EILEEN
Last Name:CECIL
Suffix:
Gender:F
Credentials:OT
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 1790
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-1790
Mailing Address - Country:US
Mailing Address - Phone:307-358-9464
Mailing Address - Fax:307-358-9330
Practice Address - Street 1:953 WALNUT ST
Practice Address - Street 2:SUITE A
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-2665
Practice Address - Country:US
Practice Address - Phone:307-322-1878
Practice Address - Fax:307-322-1879
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOT-632225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist