Healthcare Provider Details

I. General information

NPI: 1881243889
Provider Name (Legal Business Name): RACHEL KAMIN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 E TOMPKINS AVE
LAS VEGAS NV
89121-7394
US

IV. Provider business mailing address

264 MCNERNEY DR
HENDERSON NV
89012-3107
US

V. Phone/Fax

Practice location:
  • Phone: 702-262-0037
  • Fax:
Mailing address:
  • Phone: 702-336-2329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2309
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: