Provider Demographics
NPI:1063790376
Name:LALA, SHIRISH (MHS, OTR/L)
Entity type:Individual
Prefix:
First Name:SHIRISH
Middle Name:
Last Name:LALA
Suffix:
Gender:M
Credentials:MHS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 MERRIMAC ST
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-5788
Mailing Address - Country:US
Mailing Address - Phone:386-216-0398
Mailing Address - Fax:
Practice Address - Street 1:967 MERRIMAC ST
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-5788
Practice Address - Country:US
Practice Address - Phone:386-216-0398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12101225X00000X
IL056008951225X00000X
CA11895225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist