MEDICARE: MS. RAQUEL SWEAT OTR/L

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	11-0187	NV

General Provider Information

NPI Number	:	1750649349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RAQUEL SWEAT OTR/L

Provider Business Mailing Address
First Line	:	6935 ALIANTE PKWY # 104-190
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-5818
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6935 ALIANTE PKWY # 104-190
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-5818
Country	:	US
Telephone Number	:	702-398-7031
Fax Number	:

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

Provider Enumeration Date	:	05/02/2012
Last Update Date	:	03/09/2022

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