MEDICARE: BRIAN J RICHEY ATP

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	225CA2500X	Assistive Technology Supplier Rehabilitation Counselor	89467	TX
2	247200000X	Other Technician	89467	TX
3	225CA2400X	Assistive Technology Practitioner Rehabilitation Counselor	89467	TX

General Provider Information

NPI Number	:	1861969701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN J RICHEY ATP

Provider Business Mailing Address
First Line	:	1901 N GLENVILLE DR STE 501
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75081-1957
Country	:	US
Telephone Number	:	972-480-0990
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 ENTERPRISE ST STE C
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75604-5071
Country	:	US
Telephone Number	:	972-480-0990
Fax Number	:

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

Provider Enumeration Date	:	10/29/2018
Last Update Date	:	02/28/2022

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