Provider Demographics
NPI:1811178429
Name:DALAL, HIMA (OT)
Entity type:Individual
Prefix:
First Name:HIMA
Middle Name:
Last Name:DALAL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 CHARTER OAK RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9246
Mailing Address - Country:US
Mailing Address - Phone:803-359-1551
Mailing Address - Fax:803-359-0362
Practice Address - Street 1:163 CHARTER OAK RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9246
Practice Address - Country:US
Practice Address - Phone:803-359-1551
Practice Address - Fax:803-359-0362
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2626225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ06846Medicare UPIN
SCQ334840281Medicare PIN