Provider Demographics
NPI:1366022329
Name:ANGELES, JAMIE ROSE DE GUZMAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:JAMIE ROSE
Middle Name:DE GUZMAN
Last Name:ANGELES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5668 BISHOP FLOWERS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-1101
Mailing Address - Country:US
Mailing Address - Phone:702-374-4562
Mailing Address - Fax:
Practice Address - Street 1:100 DELMAR GARDENS DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-3216
Practice Address - Country:US
Practice Address - Phone:702-361-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2686225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist