Individual
MS. TRENA PRIMAVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
503 S 18TH ST, LARAMIE, WY 82070-4303
(307) 742-3728
Mailing address
250 CARROLL AVE, CHEYENNE, WY 82009-4727
(307) 630-7368
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT625
WY
Other
Enumeration date
11/14/2008
Last updated
11/14/2008
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