Individual
JESSICA RAE FAHSHOLTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1406 W MAIN ST, RIVERTON, WY 82501-3239
(307) 857-7074
(307) 856-6459
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-1811
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT-1811
OCCUPATIONAL THERAPIST
WY
Enumeration date
08/08/2024
Last updated
02/25/2026
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