Provider Demographics
NPI:1073986832
Name:ELITE OCCUPATIONAL THERAPY SERVICES
Entity Type:Organization
Organization Name:ELITE OCCUPATIONAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:POON
Authorized Official - Suffix:
Authorized Official - Credentials:MSOT
Authorized Official - Phone:408-466-4294
Mailing Address - Street 1:216 ABUNDANCE RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-5496
Mailing Address - Country:US
Mailing Address - Phone:408-466-4294
Mailing Address - Fax:
Practice Address - Street 1:8174 LAS VEGAS BLVD S
Practice Address - Street 2:SUITE 109-1250
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-1029
Practice Address - Country:US
Practice Address - Phone:408-466-4294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15-0610252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency