Jacquelyn Mota Gutierrez

Individual provider Active NPI Occupational Therapist · Las Vegas, NV

NPI 1376246264 · NPPES record last updated Mar 22, 2023

Key facts

NPI
1376246264
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapist 225X00000X
License
OT-3181 (NV)
Practice address
9050 W Cheyenne Ave Ste 210
Las Vegas, NV 89129-8932
Phone
(702) 209-0069
Fax
(702) 564-4838
NPI assigned
Mar 22, 2023
Sex
Female
Sole proprietor
No

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.

Medicare Care Compare profile

Specialty
Occupational Therapist in Private Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Affiliated Physical Therapy (47 clinicians)

Practice addresses (Care Compare)

9050 W Cheyenne Ave
Suite 210
Las Vegas, NV 89129-8932
Phone (702) 660-2694

Merit-based Incentive Payment System (MIPS)

Final score
58.17 of 100 (group)
Quality
37.51
Improvement activities
40
Cost
75.14

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NV

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20230428002151 NV Practitioner - Occupational Therapist in Private Practice 3476918319 Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
OT-3181NVMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Affiliated Physical Therapy Occupational Therapist Current
since Mar 22, 2023
Accepting new patients
Therapy West LLC Past
since Mar 22, 2023
Accepting new patients

Locations

129 W Lake Mead Pkwy
Ste 2
Henderson, NV 89015
Phone (702) 564-7309

9050 W Cheyenne Ave
#210
Las Vegas, NV 89129
Phone (702) 209-0069

1333 N Buffalo Dr
Unit 170
Las Vegas, NV 89128
Phone (702) 660-2694

3840 W Ann Rd
Ste 101B
North Las Vegas, NV 89031
Phone (702) 660-2694

2250 Postal Dr
Ste 4
Pahrump, NV 89048
Phone (775) 727-3838

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X
Occupational Therapist 225X00000X OT-3181 NV Yes

Addresses

Primary practice location

9050 W Cheyenne Ave Ste 210
Las Vegas, NV 89129-8932

Mailing address

1333 N Buffalo Dr Unit 170
Las Vegas, NV 89128-3637
Phone (702) 660-2694

Other providers in Las Vegas, NV

All providers in Las Vegas, NV · Occupational Therapist in Nevada

Sources for this page

Verify at the official NPI Registry.