Provider Demographics
NPI:1912607649
Name:SRIVASTAVA, PRASHITH (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:PRASHITH
Middle Name:
Last Name:SRIVASTAVA
Suffix:
Gender:M
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 1:1286 N MORGANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-8914
Mailing Address - Country:US
Mailing Address - Phone:317-698-6921
Mailing Address - Fax:
Practice Address - Street 1:1119 KEYSTONE WAY
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3355
Practice Address - Country:US
Practice Address - Phone:317-688-8232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31001931A225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology