MEDICARE: MR. DONATO LAZA OTR

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	11-0093	NV

General Provider Information

NPI Number	:	1952504102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONATO LAZA OTR

Provider Business Mailing Address
First Line	:	9141 CHECKERBOARD CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-2999
Country	:	US
Telephone Number	:	702-499-3764
Fax Number	:

Provider Business Practice Location Address
First Line	:	3213 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1962
Country	:	US
Telephone Number	:	702-570-6222
Fax Number	:

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

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	12/30/2014

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