Provider Demographics
NPI:1497423859
Name:AJLANI, SHAHD (COTA/L)
Entity Type:Individual
Prefix:
First Name:SHAHD
Middle Name:
Last Name:AJLANI
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51025
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-1025
Mailing Address - Country:US
Mailing Address - Phone:843-594-3032
Mailing Address - Fax:843-285-5921
Practice Address - Street 1:9730 DORCHESTER RD UNIT 206
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-9034
Practice Address - Country:US
Practice Address - Phone:843-594-3032
Practice Address - Fax:843-285-5921
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5305224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant