Basic Information
| Provider Information | |||||||||
| NPI: | 1518166776 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BHAKTA | ||||||||
| FirstName: | JAYSHREE | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17801 IMPERIAL HWY | ||||||||
| Address2: | |||||||||
| City: | YORBA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928862362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147779666 | ||||||||
| FaxNumber: | 7149615483 | ||||||||
| Practice Location | |||||||||
| Address1: | 17801 IMPERIAL HWY | ||||||||
| Address2: | |||||||||
| City: | YORBA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928862362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147779666 | ||||||||
| FaxNumber: | 7149615483 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2007 | ||||||||
| LastUpdateDate: | 07/17/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT 7949 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.