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NPI Code Detail

MEDICARE: TAVIN DERU

MEDICARE: TAVIN DERU
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
1225X00000XOccupational Therapist10429475-4201UT

General Provider Information

NPI Number : 1790281418
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAVIN DERU
Provider Business Mailing Address
First Line : 206 N 2100 W
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84116-4740
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 775 N 200 E
Second Line :
City : BRIGHAM CITY
State : UT
Zip : 84302-1303
Country : US
Telephone Number : 435-723-7777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2018
Last Update Date : 10/24/2021

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Directions to “ TAVIN DERU ” Practice Location

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