Provider Demographics
NPI:1659420735
Name:SHAH, BHAVNA (BOBBIE) K (OTR)
Entity Type:Individual
Prefix:MS
First Name:BHAVNA (BOBBIE)
Middle Name:K
Last Name:SHAH
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 1:7518 GUINEVERE DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-6190
Mailing Address - Country:US
Mailing Address - Phone:281-343-1771
Mailing Address - Fax:281-962-4135
Practice Address - Street 1:7518 GUINEVERE DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-6190
Practice Address - Country:US
Practice Address - Phone:281-343-1771
Practice Address - Fax:281-962-4135
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105802225XP0200X, 225X00000X, 251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0894081-03Medicaid