Provider Demographics
NPI:1396231676
Name:JANI, SHRUTVA (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHRUTVA
Middle Name:
Last Name:JANI
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 1:901 S ASHLAND AVE APT 1-1209
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4001
Mailing Address - Country:US
Mailing Address - Phone:630-776-9622
Mailing Address - Fax:
Practice Address - Street 1:811 W EVERGREEN AVE STE 404
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-7113
Practice Address - Country:US
Practice Address - Phone:312-242-1665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.012540225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist