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General NPI Number Information
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NPI Number | 1851656425
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Entity Type | Individual
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Provider Name | JAMES WAUGH
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Gender | Male
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | 5528 HOLCOMB BRIDGE CT
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City | LAS VEGAS
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State | NV
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Zip | 89149-4019
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Country | US
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Telephone | 603-978-8905
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Fax |
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Provider Business Mailing Address
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Address Line | 5528 HOLCOMB BRIDGE CT
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City | LAS VEGAS
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State | NV
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Zip | 89149-4019
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Country | US
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Telephone |
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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 | 11-1093
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License Number State | NV
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