MEDICARE: MS. MOLLY BEAM

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	225XP0200X	Pediatric Occupational Therapist	0792	NV

General Provider Information

NPI Number	:	1831210640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MOLLY BEAM

Provider Business Mailing Address
First Line	:	9216 BLACK SLATE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2971
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4894 W LONE MOUNTAIN RD # 143
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-2239
Country	:	US
Telephone Number	:	702-341-0402
Fax Number	:

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	06/04/2008

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