Provider Demographics
NPI:1285937417
Name:ELY, TRAVIS R
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:R
Last Name:ELY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 W WARM SPRINGS RD
Mailing Address - Street 2:SUITE 129
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-7633
Mailing Address - Country:US
Mailing Address - Phone:702-547-0201
Mailing Address - Fax:
Practice Address - Street 1:1481 W WARM SPRINGS RD
Practice Address - Street 2:SUITE 129
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-7633
Practice Address - Country:US
Practice Address - Phone:702-547-0201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1701895704225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor