Active NPI
Adam Vanvalkenburg, OT
- Occupational Therapist
- Las Vegas, NV
National Provider Identifier
1790022499
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 12-7104
- Practice address
- 8683 Brilliant Star Dr
Las Vegas, NV 89178-6503 - Phone
- (435) 862-0869
- NPI assigned
- Jan 15, 2013
- Last updated
- Jan 17, 2014
- Sex
- Male
- Sole proprietor
- Yes
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 | 12-7104 | NV | Primary |
Addresses
Primary practice location
8683 Brilliant Star Dr
Las Vegas, NV 89178-6503
Mailing address
8683 Brilliant Star Dr
Las Vegas, NV 89178-6503
Phone (435) 862-0869
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 |
|---|---|---|---|
| 12-7104 | NV | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358208000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389916800000",
"number": "1790022499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8683 BRILLIANT STAR DR",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891786503",
"telephone_number": "435-862-0869"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8683 BRILLIANT STAR DR",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891786503",
"telephone_number": "435-862-0869"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANVALKENBURG",
"first_name": "ADAM",
"credential": "OT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-01-15",
"last_updated": "2014-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NV",
"license": "12-7104",
"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 Jan 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.