Basic Information
| Provider Information | |||||||||
| NPI: | 1245839695 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DURHAM | ||||||||
| FirstName: | KASEY | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8585 S EASTERN AVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891232818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027988585 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2650 N TENAYA WAY STE 180 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891281110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022402952 | ||||||||
| FaxNumber: | 7022430482 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2020 | ||||||||
| LastUpdateDate: | 07/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT2612 | NV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.