Provider Demographics
NPI:1225512122
Name:SAMUEL, ROGER B (OTR/L)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:B
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 GREY LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-4446
Mailing Address - Country:US
Mailing Address - Phone:718-866-8810
Mailing Address - Fax:718-866-8810
Practice Address - Street 1:31 GREY LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-4446
Practice Address - Country:US
Practice Address - Phone:718-866-8810
Practice Address - Fax:718-866-8810
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025767-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist