Provider Demographics
NPI:1154996759
Name:POPE, ELSA (OTR/L)
Entity type:Individual
Prefix:
First Name:ELSA
Middle Name:
Last Name:POPE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ELSA
Other - Middle Name:
Other - Last Name:FROELICHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1771 CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-8403
Mailing Address - Country:US
Mailing Address - Phone:307-742-3571
Mailing Address - Fax:
Practice Address - Street 1:1771 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-8403
Practice Address - Country:US
Practice Address - Phone:307-742-3571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOT-1563225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist