Healthcare Provider Details

I. General information

NPI: 1437069960
Provider Name (Legal Business Name): JENNIFER GILMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N PECOS RD STE 105
HENDERSON NV
89074-1956
US

IV. Provider business mailing address

105 N PECOS RD STE 105
HENDERSON NV
89074-1956
US

V. Phone/Fax

Practice location:
  • Phone: 702-701-0057
  • Fax:
Mailing address:
  • Phone: 702-701-0057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3865
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: