Healthcare Provider Details

I. General information

NPI: 1942517834
Provider Name (Legal Business Name): MS. KELLI MICHELE OXBORROW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 GALLETTI WAY 8B
SPARKS NV
89431
US

IV. Provider business mailing address

480 GALLETTI WAY 8B
SPARKS NV
89431
US

V. Phone/Fax

Practice location:
  • Phone: 775-333-0943
  • Fax: 775-333-9425
Mailing address:
  • Phone: 775-333-0943
  • Fax: 775-333-9425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number225400000X
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: