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General NPI Number Information
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NPI Number | 1285172841
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Entity Type | Individual
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Provider Name | ANDREW JACKSON MOTR/L
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Gender | Male
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Dates
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Enumeration Date | 02/03/2017
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 8736 SHADY PINES DR
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City | LAS VEGAS
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State | NV
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Zip | 89143-4460
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Country | US
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Telephone | 435-650-7128
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Fax |
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Provider Business Mailing Address
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Address Line | 8736 SHADY PINES DR
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City | LAS VEGAS
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State | NV
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Zip | 89143-4460
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Country | US
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Telephone | 435-650-7128
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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 | 282NR1301X
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Taxonomy Name | Rural Acute Care Hospital
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License Number | 10241270-4201
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT-2211
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License Number State | NV
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