Provider Demographics
NPI:1982906822
Name:KHOKHA, SHRUTI VIKAS (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SHRUTI
Middle Name:VIKAS
Last Name:KHOKHA
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 1:14 ASHBROOK DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-4317
Mailing Address - Country:US
Mailing Address - Phone:617-840-8368
Mailing Address - Fax:
Practice Address - Street 1:14 ASHBROOK DR
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-4317
Practice Address - Country:US
Practice Address - Phone:617-840-8368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10220225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist