MEDICARE: KEVIN A SUMIDA OT

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	5497	CA
2	225X00000X	Occupational Therapist	4987	AZ
3	225X00000X	Occupational Therapist	13-0387	NV

General Provider Information

NPI Number	:	1548206790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN A SUMIDA OT

Provider Business Mailing Address
First Line	:	4855 BLUE DIAMOND RD STE 210
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-7602
Country	:	US
Telephone Number	:	725-207-3770
Fax Number	:

Provider Business Practice Location Address
First Line	:	4855 BLUE DIAMOND RD STE 210
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-7602
Country	:	US
Telephone Number	:	725-207-3770
Fax Number	:

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	12/20/2023

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Directions to “ KEVIN A SUMIDA OT” Practice Location

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