MEDICARE: RIVERSIDE REHABILITATION LLC

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	235Z00000X	Speech-Language Pathologist
2	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1528374014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE REHABILITATION LLC

Provider Business Mailing Address
First Line	:	2044 MESA PALMS DR
Second Line	:
City	:	ST GEORGE
State	:	UT
Zip	:	84770-5546
Country	:	US
Telephone Number	:	435-632-3423
Fax Number	:	435-656-2790

Provider Business Practice Location Address
First Line	:	2044 MESA PALMS DR
Second Line	:
City	:	ST GEORGE
State	:	UT
Zip	:	84770-5546
Country	:	US
Telephone Number	:	435-632-3423
Fax Number	:	435-656-2790

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	KIMBER L DOWER
Credential	:	OT
Telephone Number	:	435-632-3423

Provider Enumeration Date	:	08/23/2010
Last Update Date	:	07/06/2012

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