Provider Demographics
NPI:1346463726
Name:CHEGE, SAMUEL WAWERU
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:WAWERU
Last Name:CHEGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19731 NE 12TH CT
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-3528
Mailing Address - Country:US
Mailing Address - Phone:305-653-2790
Mailing Address - Fax:
Practice Address - Street 1:19731 NE 12TH CT
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-3528
Practice Address - Country:US
Practice Address - Phone:305-653-2790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT5868225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist