Provider Demographics
NPI:1447379409
Name:OKHOVAT, ALI (OTR)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:OKHOVAT
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 HEATHER DR
Mailing Address - Street 2:
Mailing Address - City:TELFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18969-1217
Mailing Address - Country:US
Mailing Address - Phone:215-720-5151
Mailing Address - Fax:
Practice Address - Street 1:184 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-2815
Practice Address - Country:US
Practice Address - Phone:215-247-5311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC00517L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist