Provider Demographics
NPI:1073815866
Name:SHAH, NISHA (OTR/L)
Entity Type:Individual
Prefix:
First Name:NISHA
Middle Name:
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 1:470 SOUTH HILL STREET
Mailing Address - Street 2:HELPING HANDS PEDIATRIC THERAPY, INC.
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518
Mailing Address - Country:US
Mailing Address - Phone:678-482-6100
Mailing Address - Fax:770-932-5684
Practice Address - Street 1:470 SOUTH HILL STREET
Practice Address - Street 2:HELPING HANDS PEDIATRIC THERAPY, INC.
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518
Practice Address - Country:US
Practice Address - Phone:678-482-6100
Practice Address - Fax:770-932-5684
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAOT005124225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist