MEDICARE: JEANETTE LAMOTHE

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1699284729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE LAMOTHE

Provider Business Mailing Address
First Line	:	4285 N RANCHO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3446
Country	:	US
Telephone Number	:	702-385-5331
Fax Number	:

Provider Business Practice Location Address
First Line	:	4285 NORTH RANCHO DRIVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131
Country	:	US
Telephone Number	:	702-385-5331
Fax Number	:

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

Provider Enumeration Date	:	09/20/2017
Last Update Date	:	07/21/2022

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Directions to “ JEANETTE LAMOTHE ” Practice Location

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