Healthcare Provider Details

I. General information

NPI: 1467991760
Provider Name (Legal Business Name): CHAZ RALPHS OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7495 W AZURE DR STE 140
LAS VEGAS NV
89130-4417
US

IV. Provider business mailing address

2100 LORO CT
LAS VEGAS NV
89117-1857
US

V. Phone/Fax

Practice location:
  • Phone: 702-515-4009
  • Fax:
Mailing address:
  • Phone: 801-580-1304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number14-0511
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: