Provider Demographics
NPI:1568671501
Name:WADHWA, PRIYANKA (OTR)
Entity Type:Individual
Prefix:
First Name:PRIYANKA
Middle Name:
Last Name:WADHWA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 RISING SUN LN
Mailing Address - Street 2:
Mailing Address - City:WEST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02379-1356
Mailing Address - Country:US
Mailing Address - Phone:508-559-2071
Mailing Address - Fax:508-588-1694
Practice Address - Street 1:888 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1668
Practice Address - Country:US
Practice Address - Phone:508-587-6556
Practice Address - Fax:508-588-1694
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6307225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist