Miss Shannon S Therapy 4 Kidz LLC

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

Legal business name

MISS SHANNON S THERAPY 4 KIDZ LLC

Practice address

2449 N Tenaya Way Unit 34991
Las Vegas, NV 89128-9995

Phone

(702) 970-9242

Fax

(702) 829-5857

NPI assigned

Aug 17, 2022

Organization subpart

No

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

Authorized official

Name

Shannon K Holman, OTR/LNPI 1275620270

Title

Owner/Therapist

Phone

(702) 970-9242

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Shannon Holman, OTR/L, BCP

  • Pediatric Occupational Therapist
  • Las Vegas, NV
  • NPI 1275620270

  Pediatrics

  NPD Authorized official

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

{
    "created_epoch": "1660694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686787200000",
    "number": "1982322772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2449 N TENAYA WAY UNIT 34991",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891289995",
            "telephone_number": "702-970-9242",
            "fax_number": "702-829-5857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2449 N TENAYA WAY UNIT 34991",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891289995",
            "telephone_number": "702-970-9242",
            "fax_number": "702-829-5857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISS SHANNON S THERAPY 4 KIDZ LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-17",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A",
        "authorized_official_last_name": "HOLMAN",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "702-970-9242",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003402345",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ria Mishra
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• Steven Frank Miskimens
• Rachel Anne Mismas, DDS
• Danays Miso Molina
• Mission City Community Network, Inc.
• Mission Point of Las Vegas LLC
• Mission Treatment Center
• Mission Treatment Centers
• Mission Treatment Centers, Inc.

• Pediatric Occupational Therapist in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Pediatric Occupational Therapist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; 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.