MEDICARE: EMILY ROSE ANDERSON 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	225X00000X	Occupational Therapist	OT-2538	NV

General Provider Information

NPI Number	:	1891310173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ROSE ANDERSON OTR/L

Provider Business Mailing Address
First Line	:	23511 ALISO CREEK RD APT 148
Second Line	:
City	:	ALISO VIEJO
State	:	CA
Zip	:	92656-1345
Country	:	US
Telephone Number	:	949-838-4324
Fax Number	:

Provider Business Practice Location Address
First Line	:	3985 W CHEYENNE AVE STE 306
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-8907
Country	:	US
Telephone Number	:	702-515-4009
Fax Number	:

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

Provider Enumeration Date	:	06/11/2020
Last Update Date	:	06/11/2020

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