Provider Demographics
NPI:1083235725
Name:SHAH, NIRALI GIRISH (OTR/L)
Entity Type:Individual
Prefix:
First Name:NIRALI
Middle Name:GIRISH
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 1:1843 SHENLEY PARK LN
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4922
Mailing Address - Country:US
Mailing Address - Phone:440-665-7965
Mailing Address - Fax:
Practice Address - Street 1:1843 SHENLEY PARK LN
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4922
Practice Address - Country:US
Practice Address - Phone:440-665-7965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007733225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist