MEDICARE: JANKI R NAGARSHETH OTR/L

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	225X00000X	Occupational Therapist	056011219	IL
2	225X00000X	Occupational Therapist	OTR3193	AR
3	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1194195321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANKI R NAGARSHETH OTR/L

Provider Business Mailing Address
First Line	:	3815 E MAIN ST
Second Line	:	SUITE B
City	:	ST CHARLES
State	:	IL
Zip	:	60174-2488
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1585 N MILWAUKEE AVE STE 101
Second Line	:
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-1359
Country	:	US
Telephone Number	:	847-918-7947
Fax Number	:

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

Provider Enumeration Date	:	09/30/2015
Last Update Date	:	09/06/2023

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