Provider Demographics
NPI:1700211182
Name:GOOD LIFE THERAPY, LLC
Entity Type:Organization
Organization Name:GOOD LIFE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CORINNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRENHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:702-526-5550
Mailing Address - Street 1:850 LA SCONSA DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-7562
Mailing Address - Country:US
Mailing Address - Phone:702-526-5550
Mailing Address - Fax:702-347-7649
Practice Address - Street 1:850 LA SCONSA DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-7562
Practice Address - Country:US
Practice Address - Phone:702-526-5550
Practice Address - Fax:702-347-7649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV130363225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty