Basic Information
| Provider Information | |||||||||
| NPI: | 1295114833 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TATRO | ||||||||
| FirstName: | KEELY | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 820 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RIVERTON | ||||||||
| State: | WY | ||||||||
| PostalCode: | 825013342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3078577074 | ||||||||
| FaxNumber: | 3078566459 | ||||||||
| Practice Location | |||||||||
| Address1: | 820 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RIVERTON | ||||||||
| State: | WY | ||||||||
| PostalCode: | 825013342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3078577074 | ||||||||
| FaxNumber: | 3078566459 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2015 | ||||||||
| LastUpdateDate: | 03/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 115613 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | OTR 1245 | WY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.