Provider Demographics
NPI:1073259792
Name:PATEL, VISHESHKUMAR (OTR/L)
Entity Type:Individual
Prefix:
First Name:VISHESHKUMAR
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
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 1:1869 HOLLY OAK LN
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3499
Mailing Address - Country:US
Mailing Address - Phone:215-834-6647
Mailing Address - Fax:
Practice Address - Street 1:1869 HOLLY OAK LN
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3499
Practice Address - Country:US
Practice Address - Phone:215-834-6647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7215225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist