Provider Demographics
NPI:1235977216
Name:HELLER, MATTHEW ERIC (OTA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ERIC
Last Name:HELLER
Suffix:
Gender:M
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5175 JERRY TARKANIAN WAY UNIT 21106
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-0015
Mailing Address - Country:US
Mailing Address - Phone:858-945-4366
Mailing Address - Fax:
Practice Address - Street 1:100 DELMAR GARDENS DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-3216
Practice Address - Country:US
Practice Address - Phone:702-361-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOTA3418224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant