MEDICARE: KAMAL MAHAJAN

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	OT 3251	FL

General Provider Information

NPI Number	:	1528307121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMAL MAHAJAN

Provider Business Mailing Address
First Line	:	6788 HARTLAND ST
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-1232
Country	:	US
Telephone Number	:	239-277-9619
Fax Number	:

Provider Business Practice Location Address
First Line	:	6788 HARTLAND ST
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-1232
Country	:	US
Telephone Number	:	239-277-9619
Fax Number	:

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

Provider Enumeration Date	:	02/04/2013
Last Update Date	:	02/04/2013

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Directions to “ KAMAL MAHAJAN ” Practice Location

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