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General NPI Number Information
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NPI Number | 1871860338
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Entity Type | Organization
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Legal Business Name | KIDS THERAPY LV CORPORATION
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Dates
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Enumeration Date | 11/28/2011
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Last Update Date | 09/18/2014
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Provider Practice Location Address
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Address Line | 1657 E DESERT INN RD
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City | LAS VEGAS
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State | NV
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Zip | 89169-2514
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Country | US
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Telephone | 702-534-0094
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Fax | 702-726-9527
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Provider Business Mailing Address
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Address Line | 1657 E DESERT INN RD
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City | LAS VEGAS
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State | NV
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Zip | 89169-2514
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Country | US
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Telephone | 702-534-0094
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Fax | 702-726-9527
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Authorized Official
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Title or Position | PRESIDENT
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Name | JADE MADISON
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Credential |
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Telephone | 702-499-0443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | 10-0057
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License Number State | NV
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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 | 10-0057
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 10-0057
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License Number State | NV
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