Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner |
NPI | 1457743908 |
---|---|
Provider Name | Mr. Skylar Ingalls |
First Address | Las Vegas, NV 89106-3227 |
Second Address | Las Vegas, NV 89106-3227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2015 |
Last Update Date | 20/02/2015 |