Healthcare Provider Details

I. General information

NPI: 1962509935
Provider Name (Legal Business Name): ACHIEVEMENT THERAPY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6760 W QUAIL AVE
LAS VEGAS NV
89118-2509
US

IV. Provider business mailing address

6760 W QUAIL AVE
LAS VEGAS NV
89118-2509
US

V. Phone/Fax

Practice location:
  • Phone: 702-220-5514
  • Fax: 702-212-5515
Mailing address:
  • Phone: 702-220-5514
  • Fax: 702-212-5515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1000697-320
License Number StateNV

VIII. Authorized Official

Name: TANIA STEGEN-HANSON
Title or Position: OWNER/OCCUPATIONAL THERAPIST
Credential:
Phone: 702-220-5514