Active NPI
Shanaaz Khan
- Occupational Therapist
- West Memphis, AR
National Provider Identifier
1639373673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OTR1369
- Practice address
- 610 S Avalon St
West Memphis, AR 72301-4109 - Phone
- (870) 400-3481
- NPI assigned
- Jun 13, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OTR1369 | AR | Primary |
Addresses
Primary practice location
610 S Avalon St
West Memphis, AR 72301-4109
Mailing address
9205 Speerberry Cir
Cordova, TN 38016-2399
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTR1369 | AR | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639373673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9205 SPEERBERRY CIR",
"city": "CORDOVA",
"state": "TN",
"postal_code": "380162399"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 S AVALON ST",
"city": "WEST MEMPHIS",
"state": "AR",
"postal_code": "723014109",
"telephone_number": "870-400-3481"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHAN",
"first_name": "SHANAAZ",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AR",
"license": "OTR1369",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Memphis, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.