Provider Demographics
NPI:1558569152
Name:TONEY, SAMANTHA MARIE (OT CHT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MARIE
Last Name:TONEY
Suffix:
Gender:F
Credentials:OT CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42680
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-0043
Mailing Address - Country:US
Mailing Address - Phone:512-441-6008
Mailing Address - Fax:512-326-2805
Practice Address - Street 1:4310 JAMES CASEY ST
Practice Address - Street 2:SUITE 3C
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745
Practice Address - Country:US
Practice Address - Phone:512-441-6008
Practice Address - Fax:512-326-2805
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112327225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167593601Medicaid
TX454834Medicare ID - Type Unspecified