MEDICARE: MRS. CHERISH E LLOYD OTRL

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	52253954201	UT

General Provider Information

NPI Number	:	1568508828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHERISH E LLOYD OTRL

Provider Business Mailing Address
First Line	:	13742 FRONTIER ST
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-5885
Country	:	US
Telephone Number	:	801-254-7253
Fax Number	:

Provider Business Practice Location Address
First Line	:	1952 FORT UNION BLVD
Second Line	:	SUITE 100
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-6877
Country	:	US
Telephone Number	:	801-942-3311
Fax Number	:	801-942-5955

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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