Provider Demographics
NPI:1174885784
Name:BHUSHAN, GITA (MOTR/L)
Entity type:Individual
Prefix:
First Name:GITA
Middle Name:
Last Name:BHUSHAN
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5906 PALMER DR
Mailing Address - Street 2:
Mailing Address - City:WEED
Mailing Address - State:CA
Mailing Address - Zip Code:96094-9319
Mailing Address - Country:US
Mailing Address - Phone:530-938-0525
Mailing Address - Fax:530-938-0525
Practice Address - Street 1:1515 S OREGON ST
Practice Address - Street 2:# B15
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-3475
Practice Address - Country:US
Practice Address - Phone:530-842-3082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-10
Last Update Date:2012-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6379225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist