Provider Demographics
NPI:1083627616
Name:WAIT, JODY E
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:E
Last Name:WAIT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9321 W SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4845
Mailing Address - Country:US
Mailing Address - Phone:702-645-7800
Mailing Address - Fax:702-216-9304
Practice Address - Street 1:9321 W SUNSET RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148
Practice Address - Country:US
Practice Address - Phone:702-645-7800
Practice Address - Fax:702-216-9303
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO998298225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO998298OtherCHT