Provider Demographics
NPI:1740896703
Name:SAGMANI, SHELBY (OTRL)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:SAGMANI
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:SS
Other - Middle Name:
Other - Last Name:SS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HIGHLAND AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-3035
Mailing Address - Country:US
Mailing Address - Phone:857-990-6111
Mailing Address - Fax:
Practice Address - Street 1:200 HIGHLAND AVE STE 202
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-3035
Practice Address - Country:US
Practice Address - Phone:857-990-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027233225X00000X
CA24491225X00000X
TX123107225X00000X
FLOT23076225X00000X
MI5201011005225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist