MEDICARE: DUCHESS MENCHAVEZ OTR/L

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
1	225X00000X	Occupational Therapist	0796	NV

General Provider Information

NPI Number	:	1215238845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUCHESS MENCHAVEZ OTR/L

Provider Business Mailing Address
First Line	:	4275 BURNHAM AVE STE 255
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-8204
Country	:	US
Telephone Number	:	702-380-1060
Fax Number	:	702-380-1081

Provider Business Practice Location Address
First Line	:	4275 BURNHAM AVE STE 255
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-8204
Country	:	US
Telephone Number	:	702-380-1060
Fax Number	:	702-380-1081

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

Provider Enumeration Date	:	11/12/2010
Last Update Date	:	11/12/2010

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Directions to “ DUCHESS MENCHAVEZ OTR/L” Practice Location

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