Healthcare Provider Details

I. General information

NPI: 1750219259
Provider Name (Legal Business Name): NIKITA TULSHIDAS KORGAONKAR OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MALABAR ST
LOS ANGELES CA
90063-4021
US

IV. Provider business mailing address

14584 S NORMANDIE AVE
GARDENA CA
90247-2452
US

V. Phone/Fax

Practice location:
  • Phone: 213-675-2320
  • Fax:
Mailing address:
  • Phone: 213-675-2320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number28285
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: