Provider Demographics
NPI:1689294092
Name:ILYAS, HIRA (OTR/L)
Entity Type:Individual
Prefix:
First Name:HIRA
Middle Name:
Last Name:ILYAS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3086 MANUEL ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-4893
Mailing Address - Country:US
Mailing Address - Phone:408-679-3101
Mailing Address - Fax:
Practice Address - Street 1:39159 PASEO PADRE PKWY STE 304
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1698
Practice Address - Country:US
Practice Address - Phone:510-858-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-26
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16229225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist