Provider Demographics
NPI:1245544816
Name:KOTHEKAR, PADMAJA MOHAN (MSC OTR/L)
Entity type:Individual
Prefix:MRS
First Name:PADMAJA
Middle Name:MOHAN
Last Name:KOTHEKAR
Suffix:
Gender:F
Credentials:MSC OTR/L
Other - Prefix:MISS
Other - First Name:PADMAJA
Other - Middle Name:S
Other - Last Name:DINGANKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5128 30TH AVE
Mailing Address - Street 2:#4D
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-7953
Mailing Address - Country:US
Mailing Address - Phone:718-545-8356
Mailing Address - Fax:718-545-8356
Practice Address - Street 1:5128 30TH AVE
Practice Address - Street 2:#4D
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-7953
Practice Address - Country:US
Practice Address - Phone:718-545-8356
Practice Address - Fax:718-545-8356
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007476-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist