Individual
KAITLYN DIEDRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
675 WASHINGTON, AFTON, WY 83110
(307) 885-9286
(307) 885-9287
Mailing address
PO BOX 570, MOUNTAIN VIEW, WY 82939-0570
(307) 782-6602
(307) 782-7328
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
COTA-1177
WY
Other
Enumeration date
11/14/2016
Last updated
11/14/2016
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