Provider Demographics
NPI:1871518944
Name:MISTRY, SMITA DINESH (OTR/L, CHT)
Entity type:Individual
Prefix:MRS
First Name:SMITA
Middle Name:DINESH
Last Name:MISTRY
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 COROMANDE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-0245
Mailing Address - Country:US
Mailing Address - Phone:949-331-8090
Mailing Address - Fax:
Practice Address - Street 1:4341 BIRCH ST
Practice Address - Street 2:STE 102
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1924
Practice Address - Country:US
Practice Address - Phone:949-475-1002
Practice Address - Fax:949-475-1003
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 594225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA201305036OtherCHT -CERTIFIED HAND THERAPIST
CAOT 594OtherSTATE LICENSE