Provider Demographics
NPI:1659602555
Name:VARNER, LAURA (OTR)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:VARNER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 E MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3470
Mailing Address - Country:US
Mailing Address - Phone:307-335-3471
Mailing Address - Fax:307-332-5388
Practice Address - Street 1:545 E MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3470
Practice Address - Country:US
Practice Address - Phone:307-335-3471
Practice Address - Fax:307-332-5388
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOT-962225X00000X
WYOTR-962225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1114061611Medicaid