Provider Demographics
NPI:1649328873
Name:KEFFELER, CHERYL ANNE (MOT, OTRL)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANNE
Last Name:KEFFELER
Suffix:
Gender:F
Credentials:MOT, OTRL
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 52190
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82605-2190
Mailing Address - Country:US
Mailing Address - Phone:307-472-3327
Mailing Address - Fax:307-472-0297
Practice Address - Street 1:300 LANDMARK DR STE B
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4233
Practice Address - Country:US
Practice Address - Phone:307-472-3327
Practice Address - Fax:307-472-0297
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOT-476225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY126014600Medicaid
WY126014600Medicaid