Carol Diane Davis, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OTR-509 Issued in WY

Practice address

612 Country Club Dr
Evanston, WY 82930-3252

Phone

(307) 677-0669

NPI assigned

Jan 9, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wyoming Specialized Physical Therapy IncGroup PAC ID 4486649100, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wyoming Specialized Physical Therapy Inc.

  • Physical Therapist
  • Evanston, WY
  • NPI 1336151265
  Medicare reassignment Care Compare group NPD
• Occupational Therapy Services

  • Rehabilitation Clinic/Center
  • Evanston, WY
  • NPI 1255797007
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1452297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452297600000",
    "number": "1437515285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 COUNTRY CLUB DR",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829303252",
            "telephone_number": "307-677-0669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 COUNTRY CLUB DR",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829303252",
            "telephone_number": "307-677-0669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "CAROL",
        "middle_name": "DIANE",
        "name_prefix": "Dr.",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-09",
        "last_updated": "2016-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WY",
            "license": "OTR-509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marjorie M Coyle
• Shad Fredrick Crapo, PA-C
• D McKay Francom DDS
• David R Russell OD
• Davidson Chiropractic Clinic - Evanston LLC
• Kenneth Casey Davis, D.C.
• Denise Debarre, PHD
• Justin T Dennis, P.T.
• Katherine Dent
• Depalma Pediatrics Dba Evanston Pediatrics

• Occupational Therapist in Evanston, WY
• Providers in Evanston, WY by specialty
• Occupational Therapist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.