Provider Demographics
NPI:1376117226
Name:CONNER, SAMANTHA JAYE
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:JAYE
Last Name:CONNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 TALLADEGA ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-1443
Mailing Address - Country:US
Mailing Address - Phone:954-551-4351
Mailing Address - Fax:
Practice Address - Street 1:725 TALLADEGA ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-1443
Practice Address - Country:US
Practice Address - Phone:954-551-4351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-16
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist