Provider Demographics
NPI:1215334990
Name:GNANASEKHAR, PRAVIN XAVIER (OTR/L)
Entity type:Individual
Prefix:
First Name:PRAVIN
Middle Name:XAVIER
Last Name:GNANASEKHAR
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 SAINT SIMONS LN
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-2876
Mailing Address - Country:US
Mailing Address - Phone:937-304-4244
Mailing Address - Fax:
Practice Address - Street 1:140 E WOODBURY DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2841
Practice Address - Country:US
Practice Address - Phone:937-938-1523
Practice Address - Fax:937-938-6877
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT006920225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist