Provider Demographics
NPI:1306175013
Name:SHAH, PURVI M (OTR/L)
Entity type:Individual
Prefix:
First Name:PURVI
Middle Name:M
Last Name:SHAH
Suffix:
Gender:F
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 1:1386 CALLE GALANTE
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-4059
Mailing Address - Country:US
Mailing Address - Phone:626-290-5259
Mailing Address - Fax:
Practice Address - Street 1:1386 CALLE GALANTE
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-4059
Practice Address - Country:US
Practice Address - Phone:626-290-5259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
CAOT 7617225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty