Provider Demographics
NPI:1760970008
Name:PATEL, MIRA
Entity Type:Individual
Prefix:
First Name:MIRA
Middle Name:
Last Name:PATEL
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 1:3100 NC HWY 55
Mailing Address - Street 2:STE 102
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519
Mailing Address - Country:US
Mailing Address - Phone:984-241-0017
Mailing Address - Fax:919-229-4993
Practice Address - Street 1:3100 NC HWY 55 STE 102
Practice Address - Street 2:EMERGE PEDIATRIC THERAPY
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519
Practice Address - Country:US
Practice Address - Phone:984-241-0017
Practice Address - Fax:919-229-4993
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
NC13395225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist