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NPI Code Detail

MEDICARE: LUKE GAUGHAN OT

MEDICARE: LUKE GAUGHAN OT
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10295OTHERNVLICENSE #

General Provider Information

NPI Number : 1164537221
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUKE GAUGHAN OT
Provider Business Mailing Address
First Line : 10785 W TWAIN AVE STE 250
Second Line :
City : LAS VEGAS
State : NV
Zip : 89135-3026
Country : US
Telephone Number : 725-726-7847
Fax Number :
Provider Business Practice Location Address
First Line : 4000 S EASTERN AVE STE 150
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-0840
Country : US
Telephone Number : 725-726-7847
Fax Number : 725-726-7876
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2006
Last Update Date : 01/30/2021

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Directions to “ LUKE GAUGHAN OT” Practice Location

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