Provider Demographics
NPI:1467801902
Name:DUBIN, TONYA (OTR/L)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:DUBIN
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 1:2359 CLIFFWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-5874
Mailing Address - Country:US
Mailing Address - Phone:702-812-5773
Mailing Address - Fax:
Practice Address - Street 1:2359 CLIFFWOOD DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5874
Practice Address - Country:US
Practice Address - Phone:702-812-5773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13-0306225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNEVADAMedicaid