Active NPI
Portia Lynn Maravich, OTD
- Occupational Therapist
- Las Vegas, NV
National Provider Identifier
1336751502
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT-2582
- Practice address
- 2012 S Jones Blvd
Las Vegas, NV 89146-3151 - Phone
- (702) 360-1137
- NPI assigned
- Aug 19, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT-2582 | NV | Primary |
Addresses
Primary practice location
2012 S Jones Blvd
Las Vegas, NV 89146-3151
Mailing address
95 Watson Way
Powell, OH 43065-7581
Phone (614) 634-8663
Other practice location 1
8826 S Eastern Ave Ste 115
Las Vegas, NV 89123-4826
Phone (702) 360-1137
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT-2582 | NV | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| My Left Foot Children'S Therapy | Past | Accepting new patients | |
| My Left Foot Children'S Therapy, LLC. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatric Occupational Therapist
- Las Vegas, NV
- NPI 1497810576
-
- Behavior Analyst
- Las Vegas, NV
- NPI 1043667645
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597795200000",
"number": "1336751502",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "95 WATSON WAY",
"city": "POWELL",
"state": "OH",
"postal_code": "430657581",
"telephone_number": "614-634-8663"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2012 S JONES BLVD",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891463151",
"telephone_number": "702-360-1137"
}
],
"practiceLocations": [
{
"address_1": "8826 S Eastern Ave Ste 115",
"address_purpose": "LOCATION",
"city": "Las Vegas",
"state": "NV",
"postal_code": "891234826",
"country_code": "US",
"telephone_number": "702-360-1137",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MARAVICH",
"first_name": "PORTIA",
"middle_name": "LYNN",
"credential": "OTD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-19",
"last_updated": "2020-08-19",
"certification_date": "2020-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NV",
"license": "OT-2582",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.