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Individual

ROGER WILBUR DOUGLAS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
COTA

Contact information

Practice address
3353 MENDOCINO FOREST ST, LAS VEGAS, NV 89122-3576
(702) 606-8286
Mailing address
3353 MENDOCINO FOREST ST, LAS VEGAS, NV 89122-3576
(702) 606-8286

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
08-1005
NV

Other

Enumeration date
05/18/2012
Last updated
05/18/2012
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