Healthcare Provider Details

I. General information

NPI: 1972382968
Provider Name (Legal Business Name): NICHOLAS STEVENS OT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10539 PROFESSIONAL CIR STE 201
RENO NV
89521-3858
US

IV. Provider business mailing address

5310 KIETZKE LN STE 104
RENO NV
89511-2043
US

V. Phone/Fax

Practice location:
  • Phone: 775-348-8800
  • Fax: 833-687-1419
Mailing address:
  • Phone: 775-348-8800
  • Fax: 833-687-1419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-3879
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: