Provider Demographics
NPI:1609389618
Name:SHEN, SAMANTHA (DROT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:SHEN
Suffix:
Gender:F
Credentials:DROT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 N 19TH ST # 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2001
Mailing Address - Country:US
Mailing Address - Phone:267-393-1183
Mailing Address - Fax:
Practice Address - Street 1:833 N 19TH ST # 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-2001
Practice Address - Country:US
Practice Address - Phone:267-393-1183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015444225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty