Basic Information
| Provider Information | |||||||||
| NPI: | 1891417655 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IRWIN | ||||||||
| FirstName: | TRISHA | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8808 BORLA DR | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891171101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3375237184 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8595 MEDICAL CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | PORT ARTHUR | ||||||||
| State: | TX | ||||||||
| PostalCode: | 776402428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097218600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2022 | ||||||||
| LastUpdateDate: | 09/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT-2763 | NV | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 123074 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.