MEDICARE: DR. VICTORIA JAE-EUN JO OTD, OTR/L, M.ED

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-2846	NV

General Provider Information

NPI Number	:	1992468375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTORIA JAE-EUN JO OTD, OTR/L, M.ED

Provider Business Mailing Address
First Line	:	8035 TERRA BAROSSA ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-4143
Country	:	US
Telephone Number	:	702-606-2089
Fax Number	:

Provider Business Practice Location Address
First Line	:	9348 VISTA WATERS LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-5538
Country	:	US
Telephone Number	:	702-606-2089
Fax Number	:

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

Provider Enumeration Date	:	10/21/2021
Last Update Date	:	04/17/2025

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