Provider Demographics
NPI:1487293171
Name:DESAI, POOJA TEJAS (OT)
Entity type:Individual
Prefix:
First Name:POOJA
Middle Name:TEJAS
Last Name:DESAI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:POOJA
Other - Middle Name:
Other - Last Name:JOSHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:436 E LONG AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2543
Mailing Address - Country:US
Mailing Address - Phone:704-850-9099
Mailing Address - Fax:980-247-4004
Practice Address - Street 1:436 E LONG AVE STE 1
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2543
Practice Address - Country:US
Practice Address - Phone:704-850-9099
Practice Address - Fax:980-247-4004
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5495225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1487293171Medicaid
SCTH4223Medicaid