Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 7698791-4201 | UT |
NPI | 1336443068 |
---|---|
Provider Name | Mr. Thomas N Riche |
First Address | Salt Lake City, UT 84102-3918 |
Second Address | Salt Lake City, UT 84132-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2011 |
Last Update Date | 15/11/2021 |