Basic Information
Provider Information
NPI: 1346266434
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALLMARAS
FirstName: CONNIE
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: OTR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: ALLMARAS
OtherFirstName: CONSTANCE
OtherMiddleName:  
OtherNamePrefix: MS.
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 5
Mailing Information
Address1: 306 1/2 SOUTH THURMOND
Address2:  
City: SHERIDAN
State: WY
PostalCode: 82801
CountryCode: US
TelephoneNumber: 3076747884
FaxNumber:  
Practice Location
Address1: 1898 FORT ROAD
Address2: VAMC
City: SHERIDAN
State: WY
PostalCode: 82801
CountryCode: US
TelephoneNumber: 3076723473
FaxNumber: 3076721958
Other Information
ProviderEnumerationDate: 07/14/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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