Organization
REVIVE THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACI SMITH OT (OWNER)
(307) 622-1242
Entity
Organization
Contact information
Practice address
51 TOWN CENTER DR STE 110, GILLETTE, WY 82718-5521
(307) 622-1242
(307) 333-0375
Mailing address
PO BOX 2106, GILLETTE, WY 82717-2106
(307) 622-1242
(307) 333-0375
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
02/05/2020
Last updated
03/29/2022
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