Individual
JAN S KEITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
90 ETHETE ROAD, FORT WASHAKIE, WY 82514
(307) 332-6516
(307) 332-9116
Mailing address
525 COUNTRY CLUB DR, RIVERTON, WY 82501-6228
(307) 857-2858
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
216
WY
Other
Enumeration date
01/26/2007
Last updated
07/08/2007
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