MEDICARE: OSP LLC

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

General Provider Information

NPI Number	:	1942883954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OSP LLC

Provider Business Mailing Address
First Line	:	2345 SPRUCE GOOSE ST APT C427
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-2625
Country	:	US
Telephone Number	:	240-271-5730
Fax Number	:

Provider Business Practice Location Address
First Line	:	2345 SPRUCE GOOSE ST APT C427
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-2625
Country	:	US
Telephone Number	:	240-271-5730
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	OLIVIA PETERS
Credential	:	OTR/L
Telephone Number	:	240-271-5730

Provider Enumeration Date	:	04/29/2021
Last Update Date	:	04/29/2021

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Directions to “OSP LLC ” Practice Location

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