MEDICARE: MISS PAIGE KELLY BA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225C00000X	Rehabilitation Counselor

General Provider Information

NPI Number	:	1053755488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS PAIGE KELLY BA

Provider Business Mailing Address
First Line	:	3877 BAYAMON ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6428
Country	:	US
Telephone Number	:	702-493-5998
Fax Number	:

Provider Business Practice Location Address
First Line	:	3877 BAYAMON ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6428
Country	:	US
Telephone Number	:	702-493-5998
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2013
Last Update Date	:	07/18/2024

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Directions to “ MISS PAIGE KELLY BA” Practice Location

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