Provider Demographics
NPI:1558149435
Name:BHAKTA, POONAMBEN JAYANTIBHAI (OTR)
Entity Type:Individual
Prefix:MRS
First Name:POONAMBEN
Middle Name:JAYANTIBHAI
Last Name:BHAKTA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:POONAM
Other - Middle Name:JAYANTILAL
Other - Last Name:BHAKTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:3824 KYLER GLEN RD
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2479
Mailing Address - Country:US
Mailing Address - Phone:512-507-7386
Mailing Address - Fax:
Practice Address - Street 1:13785 RESEARCH BLVD STE 125
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1826
Practice Address - Country:US
Practice Address - Phone:858-444-6510
Practice Address - Fax:877-399-3746
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123848225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist