Provider Demographics
NPI:1417626466
Name:DIBENEDETTO, SAMANTHA LEE (BS, COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LEE
Last Name:DIBENEDETTO
Suffix:
Gender:F
Credentials:BS, COTA/L
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Other - First Name:
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Mailing Address - Street 1:4208 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-8480
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4208 TERRACE DR
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-8480
Practice Address - Country:US
Practice Address - Phone:914-275-3213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-12
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY010671-01224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant