MEDICARE: TOREN NICOLE TRYON COTA/L CLT

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	224Z00000X	Occupational Therapy Assistant	681	NE
2	224Z00000X	Occupational Therapy Assistant

General Provider Information

NPI Number	:	1669032496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOREN NICOLE TRYON COTA/L CLT

Provider Business Mailing Address
First Line	:	4611 N 145TH CIR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-6643
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4611 N 145TH CIR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-6643
Country	:	US
Telephone Number	:	402-680-2874
Fax Number	:

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

Provider Enumeration Date	:	06/14/2019
Last Update Date	:	06/14/2019

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