Healthcare Provider Details

I. General information

NPI: 1922469758
Provider Name (Legal Business Name): DISHA SHAH OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16150 NE 85TH ST STE. 220
REDMOND WA
98052-3539
US

IV. Provider business mailing address

16150 NE 85TH ST STE. 220
REDMOND WA
98052
US

V. Phone/Fax

Practice location:
  • Phone: 425-558-0558
  • Fax:
Mailing address:
  • Phone: 425-558-0558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 15732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: