Healthcare Provider Details

I. General information

NPI: 1609766492
Provider Name (Legal Business Name): CHANDNI BHAKTA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4415 ARLINGTON AVE
LOS ANGELES CA
90043-1407
US

IV. Provider business mailing address

4415 ARLINGTON AVE
LOS ANGELES CA
90043-1407
US

V. Phone/Fax

Practice location:
  • Phone: 323-482-7411
  • Fax:
Mailing address:
  • Phone: 323-482-7411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number24342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: