MEDICARE: PRADIPTA KUMAR SAHU MS, OTR, CHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XH1200X	Hand Occupational Therapist	110584	TX
2	225XH1200X	Hand Occupational Therapist	0119007291	VA
3	225XH1200X	Hand Occupational Therapist	19391	CA

General Provider Information

NPI Number	:	1053564872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRADIPTA KUMAR SAHU MS, OTR, CHT

Provider Business Mailing Address
First Line	:	3650 SOUTH ST STE 204
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-1521
Country	:	US
Telephone Number	:	562-444-0100
Fax Number	:	855-608-0788

Provider Business Practice Location Address
First Line	:	3650 SOUTH ST STE 204
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-1521
Country	:	US
Telephone Number	:	562-444-0100
Fax Number	:	855-608-0788

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2008
Last Update Date	:	10/06/2020

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