Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | ||
N | 225C00000X | Rehabilitation Counselor |
NPI | 1104240258 |
---|---|
Provider Name | Amanda Teater |
First Address | Las Vegas, NV 89130 |
Second Address | Las Vegas, NV 89130-3456 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2014 |
Last Update Date | 16/12/2014 |