# OCCUPATIONAL THERAPY SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255797007
- **Authorized official:** DR. CAROL DIANE DAVIS OTR/L (OCCUPATIONAL THERAPIST)
- **Authorized official phone:** (307) 677-0669

## Contact information

- **Practice address:** 612 COUNTRY CLUB DR, EVANSTON, WY 82930-3252
- **Practice address phone:** (307) 677-0669
- **Mailing address:** 612 COUNTRY CLUB DR, EVANSTON, WY 82930-3252
- **Mailing address phone:** (307) 677-0669

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0400X | Rehabilitation Clinic/Center | OTR-509 | WY | Yes |

## Other

- **Enumeration date:** 01/09/2016
- **Last updated:** 01/09/2016