Provider Demographics
NPI:1750773552
Name:ABRAHAM, SHINY K (MOT/ OTR/L)
Entity type:Individual
Prefix:
First Name:SHINY
Middle Name:K
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:MOT/ OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 HOGELAND LN
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-1638
Mailing Address - Country:US
Mailing Address - Phone:209-743-7377
Mailing Address - Fax:
Practice Address - Street 1:604 HOGELAND LN
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-1638
Practice Address - Country:US
Practice Address - Phone:209-743-7377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005252225X00000X
PAOC009747225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist