Provider Demographics
NPI:1790242915
Name:MEHRA, MANJUSHA (DOT)
Entity Type:Individual
Prefix:MRS
First Name:MANJUSHA
Middle Name:
Last Name:MEHRA
Suffix:
Gender:F
Credentials:DOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 VESCHI LN S
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-1521
Mailing Address - Country:US
Mailing Address - Phone:914-373-6520
Mailing Address - Fax:914-373-6521
Practice Address - Street 1:908 W CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2548
Practice Address - Country:US
Practice Address - Phone:480-999-4777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-24
Last Update Date:2019-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-007506225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist