Provider Demographics
NPI:1952654998
Name:SHAH, SWATI JITENDRA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SWATI
Middle Name:JITENDRA
Last Name:SHAH
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 1:769 VAN EMBURGH AVE
Mailing Address - Street 2:
Mailing Address - City:TOWNSHIP OF WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07676-3800
Mailing Address - Country:US
Mailing Address - Phone:201-923-7928
Mailing Address - Fax:
Practice Address - Street 1:769 VAN EMBURGH AVE
Practice Address - Street 2:
Practice Address - City:TOWNSHIP OF WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07676-3800
Practice Address - Country:US
Practice Address - Phone:201-923-7928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTR001431225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist