Individual
AILEEN O'CONNELL BREW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
8168 HWY 789, LANDER, WY 82520
(307) 332-5240
(307) 332-5241
Mailing address
2002 WEST SUNSET DRIVE, SUITE 1, RIVERTON, WY 82501
(307) 856-7021
(307) 856-5541
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1001
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
312064
BLUE CROSS BLUE SHIELD
WY
Enumeration date
07/28/2006
Last updated
11/09/2007
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