=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619858925
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE SELF-CARE OT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2025
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9643 PEGGY PUBLOW AVE
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89143-1294
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-275-3933
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9643 PEGGY PUBLOW AVE
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89143-1294
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-275-3933
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OCCUPATIONAL THERAPIST
-----------------------------------------------------
Name | ANNA KETRON CUSANO
-----------------------------------------------------
Credential | OTR
-----------------------------------------------------
Telephone | 276-275-3933
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------