Provider Demographics
NPI:1073407011
Name:RAFANAN, MIKKO PANTALEON (COTA/L)
Entity type:Individual
Prefix:
First Name:MIKKO
Middle Name:PANTALEON
Last Name:RAFANAN
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10663 RABBIT RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-4282
Mailing Address - Country:US
Mailing Address - Phone:702-588-9894
Mailing Address - Fax:
Practice Address - Street 1:10663 RABBIT RIDGE CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-4282
Practice Address - Country:US
Practice Address - Phone:702-588-9894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOTA-2581224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant