Provider Demographics
NPI:1487422994
Name:WEST RIVER THERAPY LLC
Entity type:Organization
Organization Name:WEST RIVER THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPY ASSISTAT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:605-295-2782
Mailing Address - Street 1:17147 W MOLLY LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-2153
Mailing Address - Country:US
Mailing Address - Phone:605-295-2782
Mailing Address - Fax:
Practice Address - Street 1:17147 W MOLLY LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85387-2153
Practice Address - Country:US
Practice Address - Phone:605-295-2782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-13
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health