Healthcare Provider Details

I. General information

NPI: 1114315801
Provider Name (Legal Business Name): SPEAKEASY THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2015
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
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

2490 PASEO VERDE PKWY STE 155
HENDERSON NV
89074-7120
US

V. Phone/Fax

Practice location:
  • Phone: 702-515-4009
  • Fax: 702-553-3438
Mailing address:
  • Phone: 702-515-4009
  • Fax: 702-960-4169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberNV20141234749
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberNV20141234749
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberNV20141234749
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberNV20141234749
License Number StateNV
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberNV20141234749
License Number StateNV

VIII. Authorized Official

Name: KELLEY R CARTER
Title or Position: OWNER
Credential: MS, CCC-SLP, COM
Phone: 702-964-5800