MEDICARE: CHILDRENS OCCUPATIONAL THERAPY, INC

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	225X00000X	Occupational Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124674205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDRENS OCCUPATIONAL THERAPY, INC

Provider Business Mailing Address
First Line	:	9508 MOUNTAINAIR AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6219
Country	:	US
Telephone Number	:	702-271-0661
Fax Number	:

Provider Business Practice Location Address
First Line	:	9508 MOUNTAINAIR AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6219
Country	:	US
Telephone Number	:	702-271-0661
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND OCCUPATIONAL THERAPIST
Name	:	MRS. LEAH KITAINIK
Credential	:	OT
Telephone Number	:	702-271-0661

Provider Enumeration Date	:	08/14/2019
Last Update Date	:	09/05/2019

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