Provider Demographics
NPI:1124585229
Name:NITTI, SAMANTHA J (COTA/L)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:J
Last Name:NITTI
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 AWIN CIR SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-8520
Mailing Address - Country:US
Mailing Address - Phone:321-216-7674
Mailing Address - Fax:
Practice Address - Street 1:153 AWIN CIR SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-8520
Practice Address - Country:US
Practice Address - Phone:321-216-7674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant