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NPI Code Detail

MEDICARE: CLINTON TREADWAY COTA/L

MEDICARE:   CLINTON  TREADWAY  COTA/L
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
1224Z00000XOccupational Therapy AssistantOTA-2641NV

General Provider Information

NPI Number : 1205573268
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLINTON TREADWAY COTA/L
Provider Business Mailing Address
First Line : 7405 BURNHAM AVE APT 2015
Second Line :
City : LAS VEGAS
State : NV
Zip : 89123-1574
Country : US
Telephone Number : 702-565-5011
Fax Number :
Provider Business Practice Location Address
First Line : 6363 S PECOS RD STE 103
Second Line :
City : LAS VEGAS
State : NV
Zip : 89120-6291
Country : US
Telephone Number : 702-565-5011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2022
Last Update Date : 05/19/2022

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Directions to “ CLINTON TREADWAY COTA/L” Practice Location

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