Provider Demographics
NPI:1316374242
Name:JHAVERI, EKTA S (OTR/L)
Entity Type:Individual
Prefix:
First Name:EKTA
Middle Name:S
Last Name:JHAVERI
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 1:84-11 LANDER STREET
Mailing Address - Street 2:APT 7 2ND FLOOR
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435
Mailing Address - Country:US
Mailing Address - Phone:516-270-7643
Mailing Address - Fax:
Practice Address - Street 1:84-11 LANDER STREET
Practice Address - Street 2:APT 7 2ND FLOOR
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435
Practice Address - Country:US
Practice Address - Phone:516-270-7643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018350225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist