Provider Demographics
NPI:1740843150
Name:GINGRICH, ROY MATTHEW (OT)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:MATTHEW
Last Name:GINGRICH
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 E DESERT INN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3632
Mailing Address - Country:US
Mailing Address - Phone:702-294-7499
Mailing Address - Fax:702-735-0097
Practice Address - Street 1:2800 E DESERT INN RD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3632
Practice Address - Country:US
Practice Address - Phone:702-294-7499
Practice Address - Fax:702-735-0097
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOT-2190225X00000X
IA108506225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist