Revive Therapy

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Legal business name

REVIVE THERAPY

Practice address

51 Town Center Dr Ste 110
Gillette, WY 82718-5521

Phone

(307) 622-1242

Fax

(307) 333-0375

NPI assigned

Feb 5, 2020

Last updated

Mar 29, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Traci Smith, OTNPI 1194912428

Title

Owner

Phone

(307) 622-1242

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Traci Marie Smith, MS, OTR/L

  • Occupational Therapist
  • Gillette, WY
  • NPI 1194912428
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1580860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648512000000",
    "number": "1730711060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2106",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827172106",
            "telephone_number": "307-622-1242",
            "fax_number": "307-333-0375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 TOWN CENTER DR STE 110",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827185521",
            "telephone_number": "307-622-1242",
            "fax_number": "307-333-0375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-05",
        "last_updated": "2022-03-29",
        "certification_date": "2022-03-29",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "TRACI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "307-622-1242",
        "authorized_official_credential": "OT"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madonna M Reece, PMHNP
• Tara Reed, M.A., NCC, LPC
• Renewal Therapy of Wy, LLC
• Suzette Marie Renken
• Thomas Bernard Repas, DO
• Alisha Reynolds, OT
• Rheumatology & Osteoporosis Center of Wyoming LLC
• Melissa Elaine Rhoades, FNP-C
• Brodie Rice
• Denise Richards, PA

• Occupational Therapist in Gillette, WY
• Providers in Gillette, WY by specialty
• Occupational Therapist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.