Provider Demographics
NPI:1740344423
Name:MEHRA, ALKA (OCCUPATIONAL THERAPI)
Entity type:Individual
Prefix:
First Name:ALKA
Middle Name:
Last Name:MEHRA
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 INTERLACHEN LN
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-6435
Mailing Address - Country:US
Mailing Address - Phone:320-212-9234
Mailing Address - Fax:
Practice Address - Street 1:405 INTERLACHEN LN
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-6435
Practice Address - Country:US
Practice Address - Phone:320-212-9234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2014-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100559225X00000X
WI5422-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
670000623Medicare ID - Type Unspecified