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NPI Code Detail

MEDICARE: JEFFREY ROBERT TYLER OTR/L

MEDICARE: JEFFREY ROBERT TYLER OTR/L
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
1225XG0600XGerontology Occupational Therapist11796CA

General Provider Information

NPI Number : 1639415458
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY ROBERT TYLER OTR/L
Provider Business Mailing Address
First Line : 4560 SE INTERNATIONAL WAY STE 100
Second Line :
City : MILWAUKIE
State : OR
Zip : 97222-4628
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1633 CYPRESS LN
Second Line :
City : PARADISE
State : CA
Zip : 95969-2823
Country : US
Telephone Number : 530-877-9316
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2012
Last Update Date : 12/26/2012

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