Provider Demographics
NPI:1639652746
Name:CHAVEZ, JENA (OT)
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 SUTTON HILLS PL
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-9745
Mailing Address - Country:US
Mailing Address - Phone:702-742-3093
Mailing Address - Fax:
Practice Address - Street 1:290 SUTTON HILLS PL
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002-9745
Practice Address - Country:US
Practice Address - Phone:702-742-3093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist