MEDICARE: LIFESKILLS THERAPY LLC

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

General Provider Information

NPI Number	:	1558979187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESKILLS THERAPY LLC

Provider Business Mailing Address
First Line	:	101 PARKER RANCH DR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-2614
Country	:	US
Telephone Number	:	702-443-4899
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 PARKER RANCH DR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-2614
Country	:	US
Telephone Number	:	702-443-4899
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	ZETRYANA RIVERA
Credential	:	OTR/L
Telephone Number	:	702-443-4899

Provider Enumeration Date	:	07/20/2020
Last Update Date	:	07/20/2020

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