Healthcare Provider Details

I. General information

NPI: 1285365502
Provider Name (Legal Business Name): MELINDA ROSE SNYDER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N PECOS RD STE A
HENDERSON NV
89074-1350
US

IV. Provider business mailing address

3108 LA ENTRADA ST
HENDERSON NV
89014-3607
US

V. Phone/Fax

Practice location:
  • Phone: 702-566-8255
  • Fax:
Mailing address:
  • Phone: 949-357-9144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number16-0820
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: