Individual
ELLIS TIMOTHY CHARLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
511 GLADSTONE ST, 511 GLADSTONE STREET, SHERIDAN, WY 82801-4830
(307) 752-9082
Mailing address
511 GLADSTONE ST, SHERIDAN, WY 82801-4830
(307) 752-9082
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
WY
Other
Enumeration date
05/03/2017
Last updated
05/03/2017
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