Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner |
NPI | 1760082812 |
---|---|
Provider Name | Pleatheal Wesley Roberts |
First Address | Las Vegas, NV 89145-5340 |
Second Address | Las Vegas, NV 89145-5340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2020 |
Last Update Date | 28/10/2020 |