Provider Demographics
NPI:1629380340
Name:SAMIT, THEA (OTR)
Entity Type:Individual
Prefix:MS
First Name:THEA
Middle Name:
Last Name:SAMIT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-1836
Mailing Address - Country:US
Mailing Address - Phone:732-247-0161
Mailing Address - Fax:732-247-2790
Practice Address - Street 1:4151 E. 11 ST.
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:33009-1836
Practice Address - Country:US
Practice Address - Phone:732-247-0161
Practice Address - Fax:732-247-2790
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC047130001041C0700X
NY003816-1225X00000X
FLOT 5124225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical