Provider Demographics
NPI:1760904874
Name:SAMUEL, LINDSEY (OTR)
Entity Type:Individual
Prefix:MS
First Name:LINDSEY
Middle Name:
Last Name:SAMUEL
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 1:6 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863-1314
Mailing Address - Country:US
Mailing Address - Phone:1732-841-7858
Mailing Address - Fax:
Practice Address - Street 1:132 EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2484
Practice Address - Country:US
Practice Address - Phone:732-452-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00747800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist