Provider Demographics
NPI:1417439357
Name:GIEGERICH, TYLER JOHN (OTR/L)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JOHN
Last Name:GIEGERICH
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15233 GALANTE LN APT 401
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-4635
Mailing Address - Country:US
Mailing Address - Phone:952-270-2440
Mailing Address - Fax:
Practice Address - Street 1:512 49TH AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55430-3621
Practice Address - Country:US
Practice Address - Phone:612-278-7902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105752225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation