Provider Demographics
NPI:1821321308
Name:SAMPSON, MONICA SANDRA (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:SANDRA
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 WATT AVE STE B5
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-0581
Mailing Address - Country:US
Mailing Address - Phone:916-483-8282
Mailing Address - Fax:916-483-6699
Practice Address - Street 1:2222 WATT AVE STE B5
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-0581
Practice Address - Country:US
Practice Address - Phone:916-483-8282
Practice Address - Fax:916-483-6699
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2239225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist