MEDICARE: DR. MELISSA WOODS RILEY D.V.M.

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	247200000X	Other Technician	9539526-2801	UT

General Provider Information

NPI Number	:	1285189167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA WOODS RILEY D.V.M.

Provider Business Mailing Address
First Line	:	389 W 1830 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-5890
Country	:	US
Telephone Number	:	801-463-6488
Fax Number	:	801-463-6610

Provider Business Practice Location Address
First Line	:	389 W 1830 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-5890
Country	:	US
Telephone Number	:	801-463-6488
Fax Number	:	801-463-6610

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

Provider Enumeration Date	:	08/19/2016
Last Update Date	:	08/19/2016

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