Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 15-1295 | NV |
NPI | 1023550928 |
---|---|
Provider Name | Vanessa Breth |
First Address | Sparks, NV 89431-1893 |
Second Address | Sparks, NV 89431-1893 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2016 |
Last Update Date | 08/11/2016 |