MEDICARE: J.C. ROYER HEYGOOD

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
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1265717573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	J.C. ROYER HEYGOOD

Provider Business Mailing Address
First Line	:	8037 S ALASKA ST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98408-1039
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8037 S ALASKA ST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98408-1039
Country	:	US
Telephone Number	:	253-301-1796
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2011
Last Update Date	:	10/18/2011

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Directions to “ J.C. ROYER HEYGOOD ” Practice Location

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