Provider Demographics
NPI:1003980087
Name:SHUKLA, BHAVNA (OTR)
Entity Type:Individual
Prefix:
First Name:BHAVNA
Middle Name:
Last Name:SHUKLA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 W NELSON ST
Mailing Address - Street 2:# 1106
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5152
Mailing Address - Country:US
Mailing Address - Phone:773-746-2463
Mailing Address - Fax:
Practice Address - Street 1:856 W NELSON ST
Practice Address - Street 2:APT # 1106
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5152
Practice Address - Country:US
Practice Address - Phone:773-746-2463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics