Basic Information
Provider Information
NPI: 1750396545
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SIOJO-ALLEN
FirstName: ANGELITA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: OTR L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 50 W 3RD ST
Address2:  
City: SHERIDAN
State: WY
PostalCode: 828013606
CountryCode: US
TelephoneNumber: 3076722092
FaxNumber: 3076731969
Practice Location
Address1: 50 W 3RD ST
Address2:  
City: SHERIDAN
State: WY
PostalCode: 828013606
CountryCode: US
TelephoneNumber: 3076722092
FaxNumber: 3076731969
Other Information
ProviderEnumerationDate: 07/30/2006
LastUpdateDate: 12/27/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000XOTR287WYY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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