MEDICARE: DR. JAPHETH MAICO OTD, OTR-L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225XE0001X	Environmental Modification Occupational Therapist
2	225XM0800X	Mental Health Occupational Therapist
3	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1104542257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAPHETH MAICO OTD, OTR-L

Provider Business Mailing Address
First Line	:	6623 TOPLEY PIKE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-5391
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6623 TOPLEY PIKE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-5391
Country	:	US
Telephone Number	:	626-818-6947
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2022
Last Update Date	:	10/19/2022

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