Provider Demographics
NPI:1508173428
Name:PATEL, DAXA KASABWALA
Entity Type:Individual
Prefix:
First Name:DAXA
Middle Name:KASABWALA
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAXA
Other - Middle Name:KASABWALA
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:920 BRADLEY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-2208
Mailing Address - Country:US
Mailing Address - Phone:732-565-9338
Mailing Address - Fax:
Practice Address - Street 1:920 BRADLEY ST
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-2208
Practice Address - Country:US
Practice Address - Phone:732-565-9338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010151-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics