Provider Demographics
NPI:1194209775
Name:GUHA, MADHUMITA (COTA)
Entity Type:Individual
Prefix:MS
First Name:MADHUMITA
Middle Name:
Last Name:GUHA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12837 HOADLY MANOR DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-5581
Mailing Address - Country:US
Mailing Address - Phone:724-766-0971
Mailing Address - Fax:
Practice Address - Street 1:12837 HOADLY MANOR DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20112-5581
Practice Address - Country:US
Practice Address - Phone:724-766-0971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001417224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0131001417OtherCOMMONWEALTH OF VA, DEPT OF HEALTH PROFESSIONALS