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General NPI Number Information
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NPI Number | 1720567175
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Entity Type | Individual
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Provider Name | TANNER REED
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Gender | Male
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 235 W FLETCHER ST
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City | HAXTUN
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State | CO
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Zip | 80731-2737
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Country | US
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Telephone | 970-774-6123
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Fax |
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Provider Business Mailing Address
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Address Line | 235 W FLETCHER ST
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City | HAXTUN
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State | CO
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Zip | 80731-2737
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Country | US
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Telephone | 970-774-6123
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 119278
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT4426
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT.0008453
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License Number State | CO
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