Provider Demographics
NPI:1023250552
Name:LAKHANPAL, AJAY (OTR/L)
Entity type:Individual
Prefix:MR
First Name:AJAY
Middle Name:
Last Name:LAKHANPAL
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 1:14430 WOODFIELD CIR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-6422
Mailing Address - Country:US
Mailing Address - Phone:904-721-0088
Mailing Address - Fax:
Practice Address - Street 1:2802 PARENTAL HOME ROAD
Practice Address - Street 2:RIVERWOOD CENTER
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-721-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12959225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist