Provider Demographics
NPI:1386531499
Name:LUND, KYLER
Entity type:Individual
Prefix:
First Name:KYLER
Middle Name:
Last Name:LUND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5715 W ALEXANDER RD STE 155
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-2807
Mailing Address - Country:US
Mailing Address - Phone:702-701-0057
Mailing Address - Fax:702-701-0075
Practice Address - Street 1:105 N PECOS RD STE 105
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-1956
Practice Address - Country:US
Practice Address - Phone:702-701-0057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOTA-3239224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant