Brock Wahlert

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT-1719 Issued in WY

Practice address

603 E Carlson St
Cheyenne, WY 82009-4443

Phone

(307) 514-9999

Fax

(307) 514-6006

NPI assigned

Jun 7, 2022

Last updated

Aug 8, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Top Therapy, PC

  • Physical Therapy Clinic/Center
  • Cheyenne, WY
  • NPI 1861877748

  Occupational Therapist

  Medicare reassignment NPD
• Cowboy State Therapy LLC

  • Pediatric Occupational Therapist
  • Cheyenne, WY
  • NPI 1083598122
  NPD Authorized official
• Teton Therapy, P.C.

  • Physical Therapy Clinic/Center
  • Riverton, WY
  • NPI 1275564122

  Occupational Therapist

  NPD
• TLC Kid's Therapy

  • Occupational Therapist
  • San Antonio, TX
  • NPI 1114164431
  NPD (past)

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

{
    "created_epoch": "1654560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1538898358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1406 W MAIN ST",
            "city": "RIVERTON",
            "state": "WY",
            "postal_code": "825013239",
            "telephone_number": "307-463-0462",
            "fax_number": "307-856-6459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 E CARLSON ST",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820094443",
            "telephone_number": "307-514-9999",
            "fax_number": "307-514-6006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAHLERT",
        "first_name": "BROCK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-07",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WY",
            "license": "OT-1719",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "OT-1719",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ron W Waeckerlin, M.D.
• Anne S Wagner, LCSW
• Kelsey Leigh Wagner, PA
• Philip L Wagner, MD
• Megan M Wagnon, PHARMACIST
• Danielle Wakelin, OTR/L
• Wal-Mart Srores Inc (Walmart Vision Center 30-4653)
• Wal-Mart Stores, Inc. (Vision Center 30-1315)
• Jason Lawrence Walck, PHARM.D.
• Karla D Walden, M.S, R.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.