MEDICARE: CHAZ RALPHS 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	225XP0200X	Pediatric Occupational Therapist	14-0511	NV

General Provider Information

NPI Number	:	1467991760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAZ RALPHS OTR/L

Provider Business Mailing Address
First Line	:	2100 LORO CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1857
Country	:	US
Telephone Number	:	801-580-1304
Fax Number	:

Provider Business Practice Location Address
First Line	:	7495 W AZURE DR STE 140
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-4417
Country	:	US
Telephone Number	:	702-515-4009
Fax Number	:

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

Provider Enumeration Date	:	02/20/2017
Last Update Date	:	02/20/2017

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Directions to “ CHAZ RALPHS OTR/L” Practice Location

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