Provider Demographics
NPI:1417135443
Name:SHAH, LALIT J (EDD OTR/L)
Entity Type:Individual
Prefix:DR
First Name:LALIT
Middle Name:J
Last Name:SHAH
Suffix:
Gender:M
Credentials:EDD OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 ESTATE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-8885
Mailing Address - Country:US
Mailing Address - Phone:570-586-6702
Mailing Address - Fax:570-586-6702
Practice Address - Street 1:114 ESTATE DR
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-8885
Practice Address - Country:US
Practice Address - Phone:570-586-6702
Practice Address - Fax:570-586-6702
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC000530L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist