Provider Demographics
NPI:1710354618
Name:KHAWAJA, AWARISH
Entity Type:Individual
Prefix:
First Name:AWARISH
Middle Name:
Last Name:KHAWAJA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 PRITCHARD DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7103
Mailing Address - Country:US
Mailing Address - Phone:718-687-2951
Mailing Address - Fax:
Practice Address - Street 1:210 PRITCHARD DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-7103
Practice Address - Country:US
Practice Address - Phone:718-687-2951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008745-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY008745-1OtherNEW YORK STATE EDUCATION DEPARTMENT, DIVISION OF PROFESSIONAL LICENSING SERVICES