Provider Demographics
NPI:1336805324
Name:INTEGRATIVE HEALING & WELLNESS, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE HEALING & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVARES
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:702-635-5182
Mailing Address - Street 1:6787 W TROPICANA AVE STE 253
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4759
Mailing Address - Country:US
Mailing Address - Phone:702-635-5182
Mailing Address - Fax:
Practice Address - Street 1:6787 W TROPICANA AVE STE 253
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4759
Practice Address - Country:US
Practice Address - Phone:702-635-5182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-13
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty