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NPI Code Detail

MEDICARE: LISA MARIE OMALLEY

MEDICARE: LISA MARIE OMALLEY
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1205334745
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA MARIE OMALLEY
Provider Business Mailing Address
First Line : 7281 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-1592
Country : US
Telephone Number : 702-870-7050
Fax Number :
Provider Business Practice Location Address
First Line : 7281 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-1592
Country : US
Telephone Number : 702-870-7050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2018
Last Update Date : 01/30/2018

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Directions to “ LISA MARIE OMALLEY ” Practice Location

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