Provider Demographics
NPI:1578529616
Name:KINKER, SEJAL SHAH (OT)
Entity Type:Individual
Prefix:
First Name:SEJAL
Middle Name:SHAH
Last Name:KINKER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:SEJAL
Other - Middle Name:MANHAR
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7858 SHRADER RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4222
Mailing Address - Country:US
Mailing Address - Phone:804-270-1305
Mailing Address - Fax:804-273-9294
Practice Address - Street 1:7858 SHRADER RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4222
Practice Address - Country:US
Practice Address - Phone:804-270-1305
Practice Address - Fax:804-273-9294
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002806225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA194769OtherANTHEM
VA540885859OtherMULTIPLAN
VA540885859OtherFIRST HEALTH/CCN
VA1184063OtherAETNA HMO
VA540885859OtherFOCUS
VA010237351Medicaid
VA258462OtherSOUTHERN HEALTH
VA540885859OtherPHCS
VA540885859OtherCIGNA REHAB PROVIDER
VAOPTIMA HEALTHOther98999
VA540885859OtherFOCUS
VA010237351Medicaid