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General NPI Number Information
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NPI Number | 1427841808
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Entity Type | Individual
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Provider Name | RAYMOND POLYDOOR II COTA/L
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Gender | Male
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 2560 MONTESSOURI ST
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City | LAS VEGAS
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State | NV
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Zip | 89117-3061
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Country | US
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Telephone | 702-686-3008
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Fax |
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Provider Business Mailing Address
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Address Line | 2463 TRIBECA ST
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City | LAS VEGAS
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State | NV
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Zip | 89135-1143
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Country | US
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Telephone | 702-265-7531
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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 | OTA-3115
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License Number State | NV
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