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General NPI Number Information
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NPI Number | 1699147744
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Entity Type | Individual
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Provider Name | MS. ELAINE TAYLOR REICHE
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Gender | Female
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Dates
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Enumeration Date | 10/28/2015
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 2328 MOUNT HOPE RD
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City | OKEMOS
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State | MI
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Zip | 48864-2506
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Country | US
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Telephone | 512-923-2011
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Fax |
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Provider Business Mailing Address
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Address Line | 2328 MOUNT HOPE RD
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City | OKEMOS
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State | MI
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Zip | 48864-2506
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Country | US
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Telephone | 512-923-2011
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0002068
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2408
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1868
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License Number State | AL
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Taxonomy #4
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2601002655
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License Number State | MI
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