MEDICARE: THI OF DESERT VALLEY THERAPY

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	626	NV

General Provider Information

NPI Number	:	1982612826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THI OF DESERT VALLEY THERAPY

Provider Business Mailing Address
First Line	:	282 RUSTY PLANK AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4442
Country	:	US
Telephone Number	:	702-895-9102
Fax Number	:

Provider Business Practice Location Address
First Line	:	2055 E SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3829
Country	:	US
Telephone Number	:	702-735-1501
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	MARGARET J SHEN
Credential	:	BSOT
Telephone Number	:	702-735-1501

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	11/15/2007

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