Healthcare Provider Details

I. General information

NPI: 1629134549
Provider Name (Legal Business Name): ANN MARIE GOTTLIEB OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 JONES BLVD. SUITE 105
LAS VEGAS NV
89146
US

IV. Provider business mailing address

3030 JONES BLVD. SUITE 105
LAS VEGAS NV
89146
US

V. Phone/Fax

Practice location:
  • Phone: 702-360-1137
  • Fax: 702-341-1511
Mailing address:
  • Phone: 702-360-1137
  • Fax: 702-341-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0419
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: