MEDICARE: MS. ELAINE TAYLOR REICHE

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	2255A2300X	Athletic Trainer	0002068	CO
2	2255A2300X	Athletic Trainer	2408	TN
3	2255A2300X	Athletic Trainer	1868	AL
4	2255A2300X	Athletic Trainer	2601002655	MI

General Provider Information

NPI Number	:	1699147744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELAINE TAYLOR REICHE

Provider Business Mailing Address
First Line	:	2328 MOUNT HOPE RD
Second Line	:
City	:	OKEMOS
State	:	MI
Zip	:	48864-2506
Country	:	US
Telephone Number	:	512-923-2011
Fax Number	:

Provider Business Practice Location Address
First Line	:	2328 MOUNT HOPE RD
Second Line	:
City	:	OKEMOS
State	:	MI
Zip	:	48864-2506
Country	:	US
Telephone Number	:	512-923-2011
Fax Number	:

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

Provider Enumeration Date	:	10/28/2015
Last Update Date	:	09/01/2021

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