Healthcare Provider Details

I. General information

NPI: 1932461985
Provider Name (Legal Business Name): ERIC RUTSKY MSOT, OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6375 W CHARLESTON BLVD BLDG L200
LAS VEGAS NV
89146-1139
US

IV. Provider business mailing address

6375 W CHARLESTON BLVD BLDG L200
LAS VEGAS NV
89146-1139
US

V. Phone/Fax

Practice location:
  • Phone: 702-210-6612
  • Fax:
Mailing address:
  • Phone:
  • Fax: 866-883-9515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number15-0631
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number15-0631
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15-0631
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: