Provider Demographics
NPI:1619687423
Name:PATHAK, SHITAL (MOT, OTR-L, RAC-CT)
Entity Type:Individual
Prefix:
First Name:SHITAL
Middle Name:
Last Name:PATHAK
Suffix:
Gender:F
Credentials:MOT, OTR-L, RAC-CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 S HAYWORTH AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3616
Mailing Address - Country:US
Mailing Address - Phone:323-877-6659
Mailing Address - Fax:
Practice Address - Street 1:774 S PLACENTIA AVE #200,
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-9004
Practice Address - Country:US
Practice Address - Phone:323-877-6659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation