Healthcare Provider Details

I. General information

NPI: 1407662109
Provider Name (Legal Business Name): MARISA PAGAN OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7425 W AZURE DR STE 140
LAS VEGAS NV
89130-4425
US

IV. Provider business mailing address

8670 W CHEYENNE AVE STE 110
LAS VEGAS NV
89129-7457
US

V. Phone/Fax

Practice location:
  • Phone: 702-515-4009
  • Fax:
Mailing address:
  • Phone: 725-202-1497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-3577
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: