Organization
COWBOY STATE THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BROCK MARION WAHLERT OTR/L (OCCUPATIONAL THERAPIST)
(719) 821-3911
Entity
Organization
Contact information
Practice address
7008 HAWTHORNE DR, CHEYENNE, WY 82009-2513
(720) 917-5557
Mailing address
247 STINSON AVE, CHEYENNE, WY 82007-1112
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
—
—
225XF0002X
Feeding, Eating & Swallowing Occupational Therapist
—
—
225XP0019X
Physical Rehabilitation Occupational Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
585068400
—
WY
Enumeration date
08/01/2025
Last updated
08/03/2025
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