Provider Demographics
NPI:1518166776
Name:BHAKTA, JAYSHREE S (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JAYSHREE
Middle Name:S
Last Name:BHAKTA
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 1:17801 IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2362
Mailing Address - Country:US
Mailing Address - Phone:714-777-9666
Mailing Address - Fax:714-961-5483
Practice Address - Street 1:17801 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-2362
Practice Address - Country:US
Practice Address - Phone:714-777-9666
Practice Address - Fax:714-961-5483
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 7949225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist