Provider Demographics
NPI:1548242043
Name:KUMAR, MANOJ (OTR, CHT)
Entity Type:Individual
Prefix:MR
First Name:MANOJ
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 E DOUGLAS ROAD, SUITE 108
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545
Mailing Address - Country:US
Mailing Address - Phone:574-968-3520
Mailing Address - Fax:574-217-4824
Practice Address - Street 1:611 E DOUGLAS ROAD, SUITE 108
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545
Practice Address - Country:US
Practice Address - Phone:574-968-3520
Practice Address - Fax:574-217-4824
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31001173A225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201299780Medicaid
IN200332623OtherTAX ID
IND16356Medicare UPIN
IN216250AMedicare ID - Type Unspecified