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NPI Code Detail

MEDICARE: TYLER SOPER

MEDICARE: TYLER SOPER
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
1224Z00000XOccupational Therapy Assistant9073240-4202UT

General Provider Information

NPI Number : 1891295432
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER SOPER
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 : 6246 S REDWOOD RD
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84123-6600
Country : US
Telephone Number : 801-969-1420
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2018
Last Update Date : 02/20/2018

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Directions to “ TYLER SOPER ” Practice Location

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