Individual
OLIVIA MARY CLYDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
813 CY AVE, CASPER, WY 82601-4161
(307) 670-5303
Mailing address
813 CY AVE, CASPER, WY 82601-4161
(307) 670-5303
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA-1763
WY
Other
Enumeration date
02/15/2024
Last updated
02/15/2024
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