MEDICARE: ERIC MATHEW NIELSON OTRL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	3481244201	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063586634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC MATHEW NIELSON OTRL

Provider Business Mailing Address
First Line	:	6246 SO REDWOOD RD
Second Line	:	AVALON BENNION CARE CENTER
City	:	SLC
State	:	UT
Zip	:	84123
Country	:	US
Telephone Number	:	801-955-0690
Fax Number	:	801-955-2540

Provider Business Practice Location Address
First Line	:	6246 SO REDWOOD RD
Second Line	:	AVALON BENNION CARE CENTER
City	:	SLC
State	:	UT
Zip	:	84123
Country	:	US
Telephone Number	:	801-955-0690
Fax Number	:	801-955-2540

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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