Provider Demographics
NPI:1174157036
Name:SHAH, NIRAJ (OT/R)
Entity type:Individual
Prefix:
First Name:NIRAJ
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:OT/R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4134 BRYSON COVE CIR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-5020
Mailing Address - Country:US
Mailing Address - Phone:614-397-2543
Mailing Address - Fax:
Practice Address - Street 1:6099 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2004
Practice Address - Country:US
Practice Address - Phone:740-953-1184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH009708225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH009708OtherSTATE LICENSE