Healthcare Provider Details

I. General information

NPI: 1972974251
Provider Name (Legal Business Name): JAHANA DIIORIO OTR-L PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1176 WIGWAM PKWY
HENDERSON NV
89074-8154
US

IV. Provider business mailing address

1176 WIGWAM PKWY
HENDERSON NV
89074-8154
US

V. Phone/Fax

Practice location:
  • Phone: 702-825-0588
  • Fax: 702-852-0241
Mailing address:
  • Phone: 702-825-0588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number12-0253
License Number StateNV

VIII. Authorized Official

Name: MRS. JAHANA DIIORIO
Title or Position: DIRECTOR
Credential: OTR/L
Phone: 718-300-1331