Basic Information
| Provider Information | |||||||||
| NPI: | 1881107175 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARLEY | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | OTRL | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SERERINO | ||||||||
| OtherFirstName: | ERICA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 820 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RIVERTON | ||||||||
| State: | WY | ||||||||
| PostalCode: | 825013342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3078577074 | ||||||||
| FaxNumber: | 3078566459 | ||||||||
| Practice Location | |||||||||
| Address1: | 1507 STILLWATER AVE STE A | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820097358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3075149999 | ||||||||
| FaxNumber: | 3075146006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2017 | ||||||||
| LastUpdateDate: | 11/09/2017 | ||||||||
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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 | OTR-1304 | WY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.