Provider Demographics
NPI:1942595004
Name:RADHESHWAR, PURNIMA (OTR/L)
Entity Type:Individual
Prefix:
First Name:PURNIMA
Middle Name:
Last Name:RADHESHWAR
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 1:10243 LARGO SASSETTA COURT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2526
Mailing Address - Country:US
Mailing Address - Phone:248-730-2492
Mailing Address - Fax:
Practice Address - Street 1:1120 N TOWN CENTER DR
Practice Address - Street 2:SUITE NO. 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-6301
Practice Address - Country:US
Practice Address - Phone:866-960-7691
Practice Address - Fax:866-960-7692
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV09-0194225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist