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General NPI Number Information
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NPI Number | 1073986832
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Entity Type | Organization
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Legal Business Name | ELITE OCCUPATIONAL THERAPY SERVICES
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Dates
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Enumeration Date | 11/02/2015
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Last Update Date | 11/02/2015
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Provider Practice Location Address
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Address Line | 8174 LAS VEGAS BLVD S SUITE 109-1250
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City | LAS VEGAS
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State | NV
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Zip | 89123-1029
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Country | US
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Telephone | 408-466-4294
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Fax |
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Provider Business Mailing Address
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Address Line | 216 ABUNDANCE RIDGE ST
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City | HENDERSON
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State | NV
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Zip | 89012-5496
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Country | US
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Telephone | 408-466-4294
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | TIFFANY POON
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Credential | MSOT
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Telephone | 408-466-4294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 15-0610
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License Number State | NV
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