Provider Demographics
NPI:1679395321
Name:LOCKE, KADY LOUISE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:KADY
Middle Name:LOUISE
Last Name:LOCKE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3243 TALON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3376
Mailing Address - Country:US
Mailing Address - Phone:307-337-1373
Mailing Address - Fax:307-318-0631
Practice Address - Street 1:3243 TALON DR STE 100
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-3376
Practice Address - Country:US
Practice Address - Phone:307-337-1373
Practice Address - Fax:307-318-0631
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOT-1834225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist