Healthcare Provider Details

I. General information

NPI: 1104142967
Provider Name (Legal Business Name): CHELSEA GRACE BOOTH M.S., OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

874 AMERICAN PACIFIC DR
HENDERSON NV
89014-8800
US

IV. Provider business mailing address

874 AMERICAN PACIFIC DR
HENDERSON NV
89014-8800
US

V. Phone/Fax

Practice location:
  • Phone: 702-777-4808
  • Fax:
Mailing address:
  • Phone: 702-777-4808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number10-0016
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: