MEDICARE: CHRISTOPHER RYAN FRIAS 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	172V00000X	Community Health Worker
2	225X00000X	Occupational Therapist	OT-2226	NV

General Provider Information

NPI Number	:	1972852721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER RYAN FRIAS OTR/L

Provider Business Mailing Address
First Line	:	1625 MEADOWVALE WAY
Second Line	:
City	:	SPARKS
State	:	NV
Zip	:	89431-2945
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	821 N NELLIS BLVD STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-5387
Country	:	US
Telephone Number	:	702-452-4563
Fax Number	:

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

Provider Enumeration Date	:	09/06/2012
Last Update Date	:	11/18/2019

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