Provider Demographics
NPI:1902619125
Name:SHAH, MOHINI N (OTR/L)
Entity type:Individual
Prefix:
First Name:MOHINI
Middle Name:N
Last Name:SHAH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4925 BOAT LANDING DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3698
Mailing Address - Country:US
Mailing Address - Phone:904-671-2207
Mailing Address - Fax:
Practice Address - Street 1:100 GLENHAVEN DR
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6759
Practice Address - Country:US
Practice Address - Phone:618-462-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist