Basic Information
| Provider Information | |||||||||
| NPI: | 1033546536 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEVENS | ||||||||
| FirstName: | DEVAN | ||||||||
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| Credential: | MS OTR, PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1620 STIRRUP DR | ||||||||
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| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890028824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025786271 | ||||||||
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| Practice Location | |||||||||
| Address1: | 901 RANCHO LN STE 135 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891063826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023831958 | ||||||||
| FaxNumber: | 7023838235 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2013 | ||||||||
| LastUpdateDate: | 11/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0019X | 225XP0019X | NV | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.