Healthcare Provider Details

I. General information

NPI: 1881709020
Provider Name (Legal Business Name): SYLVIE LYNN EDMONDSON OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 06/07/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4980 W SAHARA AVE
LAS VEGAS NV
89146-3402
US

IV. Provider business mailing address

4980 W SAHARA AVE STE 260
LAS VEGAS NV
89146-3435
US

V. Phone/Fax

Practice location:
  • Phone: 702-820-5070
  • Fax: 702-945-0314
Mailing address:
  • Phone: 702-820-5070
  • Fax: 702-945-0314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0613
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number0613
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: