Healthcare Provider Details

I. General information

NPI: 1891018446
Provider Name (Legal Business Name): PRACHI GUDADHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2953 FOXBORO DR
SALINA KS
67401-7900
US

IV. Provider business mailing address

2953 FOXBORO DR
SALINA KS
67401-7900
US

V. Phone/Fax

Practice location:
  • Phone: 248-613-3329
  • Fax:
Mailing address:
  • Phone: 248-613-3329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17-02624
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: