Individual
SICO LY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
9260 W SUNSET RD STE 204, LAS VEGAS, NV 89148-4903
(877) 214-5160
Mailing address
1341 JEWELSTONE CIR, HENDERSON, NV 89012-4902
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Enumeration date
04/24/2020
Last updated
04/24/2020
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