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General NPI Number Information
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NPI Number | 1245378405
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Entity Type | Organization
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Legal Business Name | TERRY L RIVETT
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 535 ELLINOR AVE
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City | SHELTON
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State | WA
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Zip | 98584-3210
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Country | US
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Telephone | 360-427-6200
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Fax | 360-427-6300
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Provider Business Mailing Address
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Address Line | 535 ELLINOR AVE
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City | SHELTON
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State | WA
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Zip | 98584-3210
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Country | US
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Telephone | 360-427-6200
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Fax | 360-427-6300
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Authorized Official
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Title or Position | OWNER
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Name | MS. TERRY LYNN RIVETT
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Credential |
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Telephone | 360-427-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 602683771
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License Number State | WA
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