Provider Demographics
NPI:1922766112
Name:TABJULA, REKHA (OTR/L)
Entity Type:Individual
Prefix:
First Name:REKHA
Middle Name:
Last Name:TABJULA
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 1:730 HAWTHORNE LN APT 304
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2177
Mailing Address - Country:US
Mailing Address - Phone:908-922-1864
Mailing Address - Fax:
Practice Address - Street 1:3535 RANDOLPH RD STE 109
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1086
Practice Address - Country:US
Practice Address - Phone:704-931-8022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-04
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14602225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist