Individual
BRANDI TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
503 S 18TH ST, LARAMIE, WY 82070
(575) 430-6020
Mailing address
1075 N MCCUE ST # B201, LARAMIE, WY 82072-6771
(575) 430-6020
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3340
NM
Other
Enumeration date
07/20/2016
Last updated
05/17/2018
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