Provider Demographics
NPI:1417254574
Name:SHAH, SWATI (OT)
Entity Type:Individual
Prefix:
First Name:SWATI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BELLE MEADE PL
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-3813
Mailing Address - Country:US
Mailing Address - Phone:925-828-8240
Mailing Address - Fax:925-828-0480
Practice Address - Street 1:150 BELLE MEADE PL
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-3813
Practice Address - Country:US
Practice Address - Phone:925-828-8240
Practice Address - Fax:925-828-0480
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT7310174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist