Provider Demographics
NPI:1376626788
Name:MAHARAJ, KRISHENCLAI KRISSY
Entity Type:Individual
Prefix:MISS
First Name:KRISHENCLAI
Middle Name:KRISSY
Last Name:MAHARAJ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 TAYLOR STREET
Mailing Address - Street 2:
Mailing Address - City:LANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701
Mailing Address - Country:US
Mailing Address - Phone:740-588-2182
Mailing Address - Fax:740-588-2185
Practice Address - Street 1:1122 TAYLOR STREET
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701
Practice Address - Country:US
Practice Address - Phone:740-588-2182
Practice Address - Fax:740-588-2185
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06104225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist