Provider Demographics
NPI:1417331109
Name:MAHANTA, SADHAN (OT)
Entity type:Individual
Prefix:MR
First Name:SADHAN
Middle Name:
Last Name:MAHANTA
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45341 SEABROOK DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-3252
Mailing Address - Country:US
Mailing Address - Phone:734-656-1547
Mailing Address - Fax:734-621-7053
Practice Address - Street 1:45341 SEABROOK DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-3252
Practice Address - Country:US
Practice Address - Phone:734-656-1547
Practice Address - Fax:734-621-7053
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201004910225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology