MEDICARE: KRISTEN V. DYCHES

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	:	1518593755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN V. DYCHES

Provider Business Mailing Address
First Line	:	697 N EAST CAPITOL ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-2188
Country	:	US
Telephone Number	:	801-231-4725
Fax Number	:

Provider Business Practice Location Address
First Line	:	697 N EAST CAPITOL ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-2188
Country	:	US
Telephone Number	:	801-231-4725
Fax Number	:

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

Provider Enumeration Date	:	03/19/2020
Last Update Date	:	03/19/2020

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Directions to “ KRISTEN V. DYCHES ” Practice Location

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