Provider Demographics
NPI:1922499961
Name:KHALEDY, PALITA (OT)
Entity Type:Individual
Prefix:MS
First Name:PALITA
Middle Name:
Last Name:KHALEDY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:PALITA
Other - Middle Name:
Other - Last Name:THAMPARIPATRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:5720 RALSTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7844
Mailing Address - Country:US
Mailing Address - Phone:805-804-4168
Mailing Address - Fax:805-830-1177
Practice Address - Street 1:1855 COCHRAN ST STE 109
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2263
Practice Address - Country:US
Practice Address - Phone:805-526-2311
Practice Address - Fax:805-526-6608
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2021-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT16674225XH1200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16674OtherSTATE LICENSE
CAW268Medicare PIN