Provider Demographics
NPI:1689715708
Name:TINCH, REX L (OTR)
Entity Type:Individual
Prefix:MR
First Name:REX
Middle Name:L
Last Name:TINCH
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 314
Mailing Address - Street 2:
Mailing Address - City:SAWYER
Mailing Address - State:MI
Mailing Address - Zip Code:49125-0314
Mailing Address - Country:US
Mailing Address - Phone:269-429-0604
Mailing Address - Fax:
Practice Address - Street 1:460 YELLOW CREEK DR
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9378
Practice Address - Country:US
Practice Address - Phone:269-429-0604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT8469225X00000X
INOT31002968A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist