Individual
BROCK WAHLERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
603 E CARLSON ST, CHEYENNE, WY 82009-4443
(307) 514-9999
(307) 514-6006
Mailing address
1406 W MAIN ST, RIVERTON, WY 82501-3239
(307) 463-0462
(307) 856-6459
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-1719
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT-1719
STATE LICENSE
WY
Enumeration date
06/07/2022
Last updated
08/08/2024
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