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General NPI Number Information
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NPI Number | 1275356974
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Entity Type | Individual
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Provider Name | BO PARK OTD
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Gender | Female
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Dates
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Enumeration Date | 11/02/2024
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Last Update Date | 11/02/2024
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Provider Practice Location Address
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Address Line | 8020 W SAHARA AVE STE 160
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City | LAS VEGAS
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State | NV
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Zip | 89117-7917
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Country | US
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Telephone | 702-595-5437
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Fax | 702-425-2787
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Provider Business Mailing Address
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Address Line | 9550 W SAHARA AVE APT 2053
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City | LAS VEGAS
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State | NV
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Zip | 89117-5385
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Country | US
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Telephone | 213-422-1955
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT-3580
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License Number State | NV
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