Provider Demographics
NPI:1528450582
Name:ALTERNATIVE SPECIALTIES, LLC
Entity type:Organization
Organization Name:ALTERNATIVE SPECIALTIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:MACLENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CLT
Authorized Official - Phone:307-578-6890
Mailing Address - Street 1:317 TROUT PEAK DR
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9221
Mailing Address - Country:US
Mailing Address - Phone:307-578-6890
Mailing Address - Fax:
Practice Address - Street 1:317 TROUT PEAK DR
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-9221
Practice Address - Country:US
Practice Address - Phone:307-578-6890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JANET MACLENNAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-28
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTR 349225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1447642087OtherNPI