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NPI Code Detail

MEDICARE: JESSICA LYNN MAURER

MEDICARE: JESSICA LYNN MAURER
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 Assistant10-1016NV

General Provider Information

NPI Number : 1942698121
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA LYNN MAURER
Provider Business Mailing Address
First Line : 7024 GLACIER RIVER AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-4671
Country : US
Telephone Number : 707-267-4991
Fax Number :
Provider Business Practice Location Address
First Line : 2035 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2223
Country : US
Telephone Number : 702-386-4833
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2014
Last Update Date : 12/22/2014

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