Provider Demographics
NPI:1770237281
Name:KRYCH, SAMANTHA CECILIA (OTD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:CECILIA
Last Name:KRYCH
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-6531
Mailing Address - Country:US
Mailing Address - Phone:973-865-4424
Mailing Address - Fax:
Practice Address - Street 1:17 WATCHUNG PLZ
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4117
Practice Address - Country:US
Practice Address - Phone:973-744-0804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01031600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist