Basic Information
| Provider Information | |||||||||
| NPI: | 1578529616 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KINKER | ||||||||
| FirstName: | SEJAL | ||||||||
| MiddleName: | SHAH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | OT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SHAH | ||||||||
| OtherFirstName: | SEJAL | ||||||||
| OtherMiddleName: | MANHAR | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7858 SHRADER RD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232944222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042701305 | ||||||||
| FaxNumber: | 8042739294 | ||||||||
| Practice Location | |||||||||
| Address1: | 7858 SHRADER RD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232944222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042701305 | ||||||||
| FaxNumber: | 8042739294 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 01/12/2012 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 0119002806 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 194769 | 01 | VA | ANTHEM | OTHER | 540885859 | 01 | VA | MULTIPLAN | OTHER | 540885859 | 01 | VA | FIRST HEALTH/CCN | OTHER | 1184063 | 01 | VA | AETNA HMO | OTHER | 540885859 | 01 | VA | FOCUS | OTHER | 010237351 | 05 | VA | MEDICAID | 258462 | 01 | VA | SOUTHERN HEALTH | OTHER | 540885859 | 01 | VA | PHCS | OTHER | 540885859 | 01 | VA | CIGNA REHAB PROVIDER | OTHER | OPTIMA HEALTH | 01 | VA | 98999 | OTHER |