MEDICARE: ACHIEVEMENT THERAPY CENTER, INC.

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	1000697-320	NV

General Provider Information

NPI Number	:	1962509935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACHIEVEMENT THERAPY CENTER, INC.

Provider Business Mailing Address
First Line	:	6760 W QUAIL AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2509
Country	:	US
Telephone Number	:	702-220-5514
Fax Number	:	702-212-5515

Provider Business Practice Location Address
First Line	:	6760 W QUAIL AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2509
Country	:	US
Telephone Number	:	702-220-5514
Fax Number	:	702-212-5515

Authorized Official
Title or Position	:	OWNER/OCCUPATIONAL THERAPIST
Name	:	TANIA STEGEN-HANSON
Credential	:
Telephone Number	:	702-220-5514

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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