Provider Demographics
NPI:1396383972
Name:DOSAJ, PAYAL S (COTA)
Entity Type:Individual
Prefix:
First Name:PAYAL
Middle Name:S
Last Name:DOSAJ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:PAYAL
Other - Middle Name:U
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:2429 PHEASANT RUN DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1749
Mailing Address - Country:US
Mailing Address - Phone:562-746-3719
Mailing Address - Fax:
Practice Address - Street 1:2429 PHEASANT RUN DR
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1749
Practice Address - Country:US
Practice Address - Phone:562-746-3719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-14
Last Update Date:2019-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2960224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant