Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT10523 | FL |
NPI | 1003887241 |
---|---|
Provider Name | Mrs. Jennifer C Travers |
First Address | Las Vegas, NV 89146-6792 |
Second Address | Las Vegas, NV 89146-6792 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 24/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
887439500 | (05) | FL |
Y902F | BCBS (01) | FL |