Healthcare Provider Details

I. General information

NPI: 1700603834
Provider Name (Legal Business Name): LAVAR JOHN SNYDER OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2072 IDAHO ST
ELKO NV
89801-2627
US

IV. Provider business mailing address

248 COUNTRY CLUB PKWY
SPRING CREEK NV
89815-5830
US

V. Phone/Fax

Practice location:
  • Phone: 775-777-1276
  • Fax: 775-777-7022
Mailing address:
  • Phone: 775-777-1276
  • Fax: 775-777-7022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-3110
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: