Individual
KONDRAD R TAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MOT
Contact information
Practice address
4855 BLUE DIAMOND RD STE 210, LAS VEGAS, NV 89139-7602
(725) 207-3770
(702) 505-9020
Mailing address
6575 W TROPICANA AVE APT 1067, LAS VEGAS, NV 89103-4741
(818) 280-7468
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
181014
NV
Other
Enumeration date
08/06/2018
Last updated
10/19/2023
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