Provider Demographics
NPI:1255545869
Name:CASTLE, JEREMY CARPENA (OTR/L)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:CARPENA
Last Name:CASTLE
Suffix:
Gender:
Credentials:OTR/L
Other - Prefix:
Other - First Name:JEREMY
Other - Middle Name:CARPENA
Other - Last Name:DE LARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:5528 HOLCOMB BRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4019
Mailing Address - Country:US
Mailing Address - Phone:603-978-8904
Mailing Address - Fax:
Practice Address - Street 1:5528 HOLCOMB BRIDGE CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4019
Practice Address - Country:US
Practice Address - Phone:603-978-8904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12-0193225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist