Provider Demographics
NPI:1992468375
Name:JO, VICTORIA JAE-EUN (OTD, OTR/L, MED)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:JAE-EUN
Last Name:JO
Suffix:
Gender:F
Credentials:OTD, OTR/L, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9348 VISTA WATERS LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-5538
Mailing Address - Country:US
Mailing Address - Phone:702-606-2089
Mailing Address - Fax:
Practice Address - Street 1:9348 VISTA WATERS LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-5538
Practice Address - Country:US
Practice Address - Phone:702-606-2089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOT-2846225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist