Provider Demographics
NPI:1518139864
Name:SHROFF, NIMISHA M (OTR/L)
Entity Type:Individual
Prefix:
First Name:NIMISHA
Middle Name:M
Last Name:SHROFF
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706B W BEN WHITE BLVD
Mailing Address - Street 2:SUITE NUMBER:160B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7153
Mailing Address - Country:US
Mailing Address - Phone:512-293-9849
Mailing Address - Fax:888-316-7855
Practice Address - Street 1:706B W BEN WHITE BLVD
Practice Address - Street 2:SUITE NUMBER:160B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7153
Practice Address - Country:US
Practice Address - Phone:512-293-9849
Practice Address - Fax:888-316-7855
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108486225X00000X
246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX454834Medicare Oscar/Certification