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NPI Code Detail

MEDICARE: TERRIE RENA PETTIGREW

MEDICARE: TERRIE RENA PETTIGREW
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
1224Z00000XOccupational Therapy Assistant1068NV

General Provider Information

NPI Number : 1669765897
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRIE RENA PETTIGREW
Provider Business Mailing Address
First Line : 2250 E FLAMINGO RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-5170
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2250 E FLAMINGO RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-5170
Country : US
Telephone Number : 702-784-4300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2011
Last Update Date : 05/20/2011

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Directions to “ TERRIE RENA PETTIGREW ” Practice Location

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