Healthcare Provider Details

I. General information

NPI: 1245104306
Provider Name (Legal Business Name): SAMARA NICOLE HOWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 PASEO VERDE PKWY STE 115
HENDERSON NV
89074-7121
US

IV. Provider business mailing address

7600 S JONES BLVD APT 1029
LAS VEGAS NV
89139-0517
US

V. Phone/Fax

Practice location:
  • Phone: 702-515-4009
  • Fax:
Mailing address:
  • Phone: 702-305-6160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA-3760
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: