Provider Demographics
NPI:1508905944
Name:PATEL, MANISH (OTRL)
Entity Type:Individual
Prefix:
First Name:MANISH
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-2717
Mailing Address - Country:US
Mailing Address - Phone:215-455-5370
Mailing Address - Fax:215-455-5374
Practice Address - Street 1:3251 CEDAR ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4514
Practice Address - Country:US
Practice Address - Phone:215-427-2242
Practice Address - Fax:215-427-2433
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC-006841L225X00000X, 225XH1200X
PAOC-006481L225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation