Provider Demographics
NPI:1376968859
Name:MOTEN, UNIQUE NIKENYA
Entity Type:Individual
Prefix:
First Name:UNIQUE
Middle Name:NIKENYA
Last Name:MOTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:UNIQUE
Other - Middle Name:NIKENYA
Other - Last Name:OGLESBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4112 DEEP SPACE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032
Mailing Address - Country:US
Mailing Address - Phone:702-600-4914
Mailing Address - Fax:
Practice Address - Street 1:4112 DEEP SPACE ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032
Practice Address - Country:US
Practice Address - Phone:702-600-4914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner