Provider Demographics
NPI:1124394093
Name:SHAH, MEENA R (OT)
Entity Type:Individual
Prefix:MRS
First Name:MEENA
Middle Name:R
Last Name:SHAH
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 1:7 GLACIER CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1090
Mailing Address - Country:US
Mailing Address - Phone:847-620-2189
Mailing Address - Fax:
Practice Address - Street 1:124 WINDSOR PARK DR
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-1986
Practice Address - Country:US
Practice Address - Phone:630-510-2924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.005171225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist