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General NPI Number Information
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NPI Number | 1235977216
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Entity Type | Individual
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Provider Name | MATTHEW ERIC HELLER OTA
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Gender | Male
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Dates
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Enumeration Date | 07/16/2024
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Last Update Date | 07/16/2024
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Provider Practice Location Address
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Address Line | 100 DELMAR GARDENS DR
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City | HENDERSON
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State | NV
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Zip | 89074-3216
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Country | US
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Telephone | 702-361-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 5175 JERRY TARKANIAN WAY UNIT 21106
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City | LAS VEGAS
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State | NV
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Zip | 89148-0015
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Country | US
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Telephone | 858-945-4366
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA3418
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License Number State | NV
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