Provider Demographics
NPI:1861709149
Name:MCPHIE, JENNIFER WALKER (OTR/L)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WALKER
Last Name:MCPHIE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1086
Mailing Address - Street 2:62 KELLY LANE
Mailing Address - City:DAYTON
Mailing Address - State:WY
Mailing Address - Zip Code:82836-1086
Mailing Address - Country:US
Mailing Address - Phone:307-461-1526
Mailing Address - Fax:
Practice Address - Street 1:625 E 5TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-3171
Practice Address - Country:US
Practice Address - Phone:307-672-5631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTR-586225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics