Provider Demographics
NPI:1144483330
Name:STAFFORD, ANNI JEAN (MOTR L)
Entity type:Individual
Prefix:MRS
First Name:ANNI
Middle Name:JEAN
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:MOTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 S DOUGLAS HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-4982
Mailing Address - Country:US
Mailing Address - Phone:307-670-9191
Mailing Address - Fax:307-670-9193
Practice Address - Street 1:1211 S DOUGLAS HWY STE 100
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-4982
Practice Address - Country:US
Practice Address - Phone:307-670-9191
Practice Address - Fax:307-670-9193
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOT633L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist