Provider Demographics
NPI:1568803039
Name:BAJAJ, POONAM (OTR)
Entity Type:Individual
Prefix:MRS
First Name:POONAM
Middle Name:
Last Name:BAJAJ
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 1:10831 BARRINGTON BRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-6401
Mailing Address - Country:US
Mailing Address - Phone:408-409-2436
Mailing Address - Fax:
Practice Address - Street 1:10831 BARRINGTON BRIDGE CT
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-6401
Practice Address - Country:US
Practice Address - Phone:408-409-2436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10200225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology