Provider Demographics
NPI:1720066368
Name:GUPTA, AKSHAY A (MS,MA,OTR/L)
Entity Type:Individual
Prefix:
First Name:AKSHAY
Middle Name:A
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MS,MA,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:327 GUNDERSEN DR
Practice Address - Street 2:SUITE C
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2402
Practice Address - Country:US
Practice Address - Phone:630-784-3251
Practice Address - Fax:630-665-8188
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-002368225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202845108Medicare PIN
ILK04431Medicare ID - Type Unspecified