Provider Demographics
NPI:1548247612
Name:MEHRA, SHUBHRA ADITI (BSC OTRL)
Entity type:Individual
Prefix:
First Name:SHUBHRA
Middle Name:ADITI
Last Name:MEHRA
Suffix:
Gender:F
Credentials:BSC OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 WHITE EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-4601
Mailing Address - Country:US
Mailing Address - Phone:847-691-6516
Mailing Address - Fax:630-579-5875
Practice Address - Street 1:3108 WHITE EAGLE DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-4601
Practice Address - Country:US
Practice Address - Phone:847-691-6516
Practice Address - Fax:630-579-5875
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2007-08-20
Deactivation Date:2006-05-18
Deactivation Code:
Reactivation Date:2007-02-06
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist