MEDICARE: MRS. JANET CAROL WILLOUGHBY MS OTRL

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	11-0084	NV

General Provider Information

NPI Number	:	1477729333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANET CAROL WILLOUGHBY MS OTRL

Provider Business Mailing Address
First Line	:	840 PURDY LODGE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-6043
Country	:	US
Telephone Number	:	727-492-5935
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6792
Country	:	US
Telephone Number	:	702-360-1137
Fax Number	:	702-341-1511

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

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	02/28/2011

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