Provider Demographics
NPI:1962590257
Name:KHANNA, SONIKA (OT)
Entity type:Individual
Prefix:
First Name:SONIKA
Middle Name:
Last Name:KHANNA
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 1:5440 SEABREEZE LN
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-7449
Mailing Address - Country:US
Mailing Address - Phone:586-979-0026
Mailing Address - Fax:
Practice Address - Street 1:33497 23 MILE RD STE 170
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-1918
Practice Address - Country:US
Practice Address - Phone:586-716-1278
Practice Address - Fax:586-716-1282
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005931225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist