Provider Demographics
NPI:1235825621
Name:BUSACAY, MARISOL MATEO (OTR/L)
Entity Type:Individual
Prefix:DR
First Name:MARISOL
Middle Name:MATEO
Last Name:BUSACAY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6778 PAINTED MORNING AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-3602
Mailing Address - Country:US
Mailing Address - Phone:702-427-4682
Mailing Address - Fax:
Practice Address - Street 1:8020 W SAHARA AVE STE 160
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7917
Practice Address - Country:US
Practice Address - Phone:702-595-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOT-3200225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics