MEDICARE: MANISHA DESAI 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	225XE1200X	Ergonomics Occupational Therapist	103541	TX

General Provider Information

NPI Number	:	1821630112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANISHA DESAI OTR

Provider Business Mailing Address
First Line	:	6507 LUPTON DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-2324
Country	:	US
Telephone Number	:	919-812-7411
Fax Number	:

Provider Business Practice Location Address
First Line	:	6507 LUPTON DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-2324
Country	:	US
Telephone Number	:	919-812-7411
Fax Number	:

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

Provider Enumeration Date	:	10/08/2019
Last Update Date	:	10/08/2019

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Directions to “ MANISHA DESAI OTR” Practice Location

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