Provider Demographics
NPI:1487712477
Name:WONSER, MARLA JEAN (MSOT, OTR,L)
Entity type:Individual
Prefix:MS
First Name:MARLA
Middle Name:JEAN
Last Name:WONSER
Suffix:
Gender:F
Credentials:MSOT, OTR,L
Other - Prefix:MS
Other - First Name:MARLA
Other - Middle Name:JEAN
Other - Last Name:WONSER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:3401 STAGECOACH DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-5446
Mailing Address - Country:US
Mailing Address - Phone:307-237-1561
Mailing Address - Fax:307-268-3034
Practice Address - Street 1:3401 STAGECOACH DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-5446
Practice Address - Country:US
Practice Address - Phone:307-237-1561
Practice Address - Fax:307-268-3034
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY250225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY122217103Medicaid