Provider Demographics
NPI:1699147744
Name:REICHE, ELAINE TAYLOR
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:TAYLOR
Last Name:REICHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2328 MOUNT HOPE RD
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2506
Mailing Address - Country:US
Mailing Address - Phone:512-923-2011
Mailing Address - Fax:
Practice Address - Street 1:2328 MOUNT HOPE RD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2506
Practice Address - Country:US
Practice Address - Phone:512-923-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00020682255A2300X
TN24082255A2300X
AL18682255A2300X
MI26010026552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer