Individual
MARIAH IGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1103 E BOXELDER RD, GILLETTE, WY 82718-5582
(307) 686-8177
Mailing address
1103 E BOXELDER RD STE U, GILLETTE, WY 82718-5582
(307) 686-8177
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
225X00000X
Occupational Therapist
Primary
OT-1925
WY
Other
Enumeration date
02/08/2018
Last updated
03/24/2026
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