Provider Demographics
NPI:1750435335
Name:DEDIC L AMI, KAREY SUZANNE (MSOTR L)
Entity type:Individual
Prefix:MRS
First Name:KAREY
Middle Name:SUZANNE
Last Name:DEDIC L AMI
Suffix:
Gender:F
Credentials:MSOTR L
Other - Prefix:MS
Other - First Name:KAREY
Other - Middle Name:SUZANNE
Other - Last Name:DEDIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOTR L
Mailing Address - Street 1:201 E 2ND ST
Mailing Address - Street 2:SUITE 18
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2582
Mailing Address - Country:US
Mailing Address - Phone:307-472-3327
Mailing Address - Fax:307-472-0297
Practice Address - Street 1:201 E 2ND ST
Practice Address - Street 2:SUITE 18
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2582
Practice Address - Country:US
Practice Address - Phone:307-472-3327
Practice Address - Fax:307-472-0297
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTR-459225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist