MEDICARE: JENIFER MAWAE

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	224Z00000X	Occupational Therapy Assistant	15-1301	NV

General Provider Information

NPI Number	:	1124501903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENIFER MAWAE

Provider Business Mailing Address
First Line	:	6265 HILL HAVEN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-2347
Country	:	US
Telephone Number	:	360-281-6608
Fax Number	:

Provider Business Practice Location Address
First Line	:	6265 HILL HAVEN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-2347
Country	:	US
Telephone Number	:	360-281-6608
Fax Number	:

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

Provider Enumeration Date	:	09/08/2018
Last Update Date	:	09/08/2018

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Directions to “ JENIFER MAWAE ” Practice Location

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