Provider Demographics
NPI:1578974804
Name:JAMBHEKAR, MANGAL R (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:MRS
First Name:MANGAL
Middle Name:R
Last Name:JAMBHEKAR
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LORI LN
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-5243
Mailing Address - Country:US
Mailing Address - Phone:781-961-2239
Mailing Address - Fax:
Practice Address - Street 1:1 LORI LN
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-5243
Practice Address - Country:US
Practice Address - Phone:781-961-2239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1538225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist