Provider Demographics
NPI:1215949375
Name:DASTUR-ESCALANTE, KHURSHID (OT)
Entity type:Individual
Prefix:
First Name:KHURSHID
Middle Name:
Last Name:DASTUR-ESCALANTE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25706 HOOD WAY
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1403
Mailing Address - Country:US
Mailing Address - Phone:818-402-2132
Mailing Address - Fax:
Practice Address - Street 1:25706 HOOD WAY
Practice Address - Street 2:
Practice Address - City:STEVENSON RANCH
Practice Address - State:CA
Practice Address - Zip Code:91381-1403
Practice Address - Country:US
Practice Address - Phone:818-402-2132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT2305225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT2305OtherOCCUPATIONAL THERAPIST
CAWOT2305AMedicare ID - Type Unspecified