Provider Demographics
NPI:1245839695
Name:DURHAM, KASEY (OTR/L)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:DURHAM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8585 S EASTERN AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2818
Mailing Address - Country:US
Mailing Address - Phone:702-798-8585
Mailing Address - Fax:
Practice Address - Street 1:2650 N TENAYA WAY STE 180
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1110
Practice Address - Country:US
Practice Address - Phone:702-240-2952
Practice Address - Fax:702-243-0482
Is Sole Proprietor?:No
Enumeration Date:2020-10-17
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOT2612225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist