MEDICARE: PRITI SANGHVI SHAH OT

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

General Provider Information

NPI Number	:	1568596419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRITI SANGHVI SHAH OT

Provider Business Mailing Address
First Line	:	1211 HAMBURG TPKE STE 306
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-5056
Country	:	US
Telephone Number	:	973-706-8270
Fax Number	:	973-706-8272

Provider Business Practice Location Address
First Line	:	1211 HAMBURG TPKE STE 306
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-5056
Country	:	US
Telephone Number	:	973-706-8270
Fax Number	:	973-706-8272

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	06/09/2010

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