Provider Demographics
NPI:1316263049
Name:GARRARD, LAURA E (CMT, NCTMB)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:E
Last Name:GARRARD
Suffix:
Gender:F
Credentials:CMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12766
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-2766
Mailing Address - Country:US
Mailing Address - Phone:307-690-5308
Mailing Address - Fax:
Practice Address - Street 1:430 SOUTH JACKSON STREET
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001
Practice Address - Country:US
Practice Address - Phone:307-690-5308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY316749OtherBLUE CROSS BLUE SHIELD OF WYOMING