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General NPI Number Information
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NPI Number | 1720884992
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Entity Type | Individual
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Provider Name | SHANA MANGALDAS OTR/L, CLT
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Gender | Female
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 4721 N CLARK ST STE 1S
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City | CHICAGO
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State | IL
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Zip | 60640-7553
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Country | US
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Telephone | 773-770-3682
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Fax |
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Provider Business Mailing Address
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Address Line | 8202 CHESTERTON DR
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City | WOODRIDGE
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State | IL
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Zip | 60517-8027
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Country | US
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Telephone | 832-544-0006
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XE1200X
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Taxonomy Name | Ergonomics Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056.013933
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License Number State | IL
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