Provider Demographics
NPI:1699243857
Name:SHAH, RISHITA (OT)
Entity type:Individual
Prefix:
First Name:RISHITA
Middle Name:
Last Name:SHAH
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 1:411 CAMINO DEL RIO SO. STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108
Mailing Address - Country:US
Mailing Address - Phone:619-574-8181
Mailing Address - Fax:619-574-0802
Practice Address - Street 1:411 CAMINO DEL RIO SO. STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:619-574-8181
Practice Address - Fax:619-574-0802
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
CA19214225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist