MEDICARE: REGINALD RENARD MITCHELL JR. OTR/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
1	225X00000X	Occupational Therapist	OT-2570	NV

General Provider Information

NPI Number	:	1245964766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINALD RENARD MITCHELL JR. OTR/L

Provider Business Mailing Address
First Line	:	6121 GRANDROSS CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-4827
Country	:	US
Telephone Number	:	904-334-2763
Fax Number	:

Provider Business Practice Location Address
First Line	:	5840 W SUNSET RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3449
Country	:	US
Telephone Number	:	702-967-6100
Fax Number	:

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

Provider Enumeration Date	:	07/11/2022
Last Update Date	:	07/11/2022

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