Healthcare Provider Details

I. General information

NPI: 1275930653
Provider Name (Legal Business Name): LYNNETTE ZULQUAIRNAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 02/23/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 TRASIMENO PLACE
HENDERSON NV
89044
US

IV. Provider business mailing address

675 S GREEN VALLEY PKWY # 1174
HENDERSON NV
89052-0404
US

V. Phone/Fax

Practice location:
  • Phone: 702-406-9974
  • Fax:
Mailing address:
  • Phone: 702-406-9974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224ZF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapy Assistant
License NumberOT-2664
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License NumberOT-2664
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License NumberOT-2664
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOT-2664
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT-2664
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT-2664
License Number StateNV
# 7
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-2664
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: