MEDICARE: MRS. NIMISHA RAJESH PRADHAN BSC OT, BSC PSYCH

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
2	225X00000X	Occupational Therapist	3501	CA

General Provider Information

NPI Number	:	1922335033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NIMISHA RAJESH PRADHAN BSC OT, BSC PSYCH

Provider Business Mailing Address
First Line	:	950 W D ST
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-3026
Country	:	US
Telephone Number	:	909-983-9803
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 N ALLYN AVE
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91764-3805
Country	:	US
Telephone Number	:	909-983-9803
Fax Number	:

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

Provider Enumeration Date	:	11/10/2009
Last Update Date	:	12/15/2025

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