Provider Demographics
NPI:1396184529
Name:BEVERLY W BURNETT PEDIATRIC OCCUPATIONAL THERAPY PLLC
Entity Type:Organization
Organization Name:BEVERLY W BURNETT PEDIATRIC OCCUPATIONAL THERAPY PLLC
Other - Org Name:PLAY AND LEARN PEDIATRIC OCCUPATIONAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-250-7872
Mailing Address - Street 1:2505 WIMBLEDON DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2314
Mailing Address - Country:US
Mailing Address - Phone:702-250-7872
Mailing Address - Fax:
Practice Address - Street 1:3900 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1628
Practice Address - Country:US
Practice Address - Phone:702-250-7872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0018225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty