Individual
KARLIE BOOMGARDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
50 W 3RD ST, SHERIDAN, WY 82801-3606
(406) 728-9162
Mailing address
50 W 3RD ST, SHERIDAN, WY 82801-3606
(307) 672-2092
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA-1178
WY
224Z00000X
Occupational Therapy Assistant
OTA-4076
MT
Other
Enumeration date
03/12/2019
Last updated
08/20/2019
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