NPIMap

Organization Active NPI

Shadow Creek LLC

  • Occupational Therapist
  • Las Vegas, NV
National Provider Identifier
1871946558
Registry record updated Jul 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
12-0188 Issued in NV
Legal business name
SHADOW CREEK LLC
Practice address
2804 Shadow Creek Cir
Las Vegas, NV 89117-2437
Phone
(801) 380-9724
NPI assigned
Jul 19, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Emily Davis, OTR/LNPI 1528430683
Title
Owner
Phone
(801) 380-9724

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 1402 NV
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X 12-0188 NV Primary

Addresses

Primary practice location

2804 Shadow Creek Cir
Las Vegas, NV 89117-2437

Mailing address

2804 Shadow Creek Cir
Las Vegas, NV 89117-2437
Phone (801) 380-9724

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1468886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468886400000",
    "number": "1871946558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2804 SHADOW CREEK CIR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891172437",
            "telephone_number": "801-380-9724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2804 SHADOW CREEK CIR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891172437",
            "telephone_number": "801-380-9724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADOW CREEK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-19",
        "last_updated": "2016-07-19",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-380-9724",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NV",
            "license": "1402",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "NV",
            "license": "12-0188",
            "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 Jul 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.