Healthcare Provider Details

I. General information

NPI: 1164810479
Provider Name (Legal Business Name): MRS. ALISHA LEE HUTCHASON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5916 TIPPERARY ST
LAS VEGAS NV
89130-7286
US

IV. Provider business mailing address

5916 TIPPERARY ST
LAS VEGAS NV
89130-7286
US

V. Phone/Fax

Practice location:
  • Phone: 702-528-1167
  • Fax:
Mailing address:
  • Phone: 702-528-1167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1167
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: