Provider Demographics
NPI:1144888108
Name:MANSI DALAL OTD OTR-L PLLC
Entity type:Organization
Organization Name:MANSI DALAL OTD OTR-L PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANSI
Authorized Official - Middle Name:
Authorized Official - Last Name:DALAL
Authorized Official - Suffix:
Authorized Official - Credentials:OTD OTR/L
Authorized Official - Phone:323-336-1991
Mailing Address - Street 1:711 122ND AVE NE APT A4
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-3143
Mailing Address - Country:US
Mailing Address - Phone:323-336-1991
Mailing Address - Fax:
Practice Address - Street 1:12835 NE BEL RED RD STE 303
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2625
Practice Address - Country:US
Practice Address - Phone:323-336-1991
Practice Address - Fax:425-615-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA