Provider Demographics
NPI:1023033099
Name:TADYCH, GENA AVEY (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:GENA
Middle Name:AVEY
Last Name:TADYCH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:GENA
Other - Middle Name:LYNN
Other - Last Name:AVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1301 MONUMENT CT
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-3187
Mailing Address - Country:US
Mailing Address - Phone:970-858-1838
Mailing Address - Fax:
Practice Address - Street 1:2121 NORTH AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6428
Practice Address - Country:US
Practice Address - Phone:970-244-1335
Practice Address - Fax:970-244-1323
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTR-352225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist