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General NPI Number Information
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NPI Number | 1235560889
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Entity Type | Organization
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Legal Business Name | NEW VISION REHABILITATION
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 12/09/2013
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Provider Practice Location Address
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Address Line | 120 WEST PEARL AVE
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City | JACKSON
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State | WY
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Zip | 83001
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Country | US
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Telephone | 307-699-7478
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9698
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City | JACKSON
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State | WY
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Zip | 83002-9698
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Country | US
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Telephone | 307-699-7478
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. KRISTOPHER ALLISON
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Credential |
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Telephone | 307-699-7478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OTR-699
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License Number State | WY
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