MEDICARE: MS. URSULA PANKAJ SHAH OTR

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	225XP0200X	Pediatric Occupational Therapist	46TR00197600	NJ

General Provider Information

NPI Number	:	1497909782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. URSULA PANKAJ SHAH OTR

Provider Business Mailing Address
First Line	:	18 DEARBORN DR
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-1276
Country	:	US
Telephone Number	:	732-778-6854
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 DEARBORN DR
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-1276
Country	:	US
Telephone Number	:	732-778-6854
Fax Number	:

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

Provider Enumeration Date	:	11/12/2008
Last Update Date	:	11/12/2008

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