Provider Demographics
NPI:1851936884
Name:SAMANIEGO, JOHN (OTR)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SAMANIEGO
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 HAINE DR APT 1007
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7816
Mailing Address - Country:US
Mailing Address - Phone:956-454-6803
Mailing Address - Fax:
Practice Address - Street 1:1145 ROSS ST STE E
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-4338
Practice Address - Country:US
Practice Address - Phone:956-361-6000
Practice Address - Fax:956-361-6060
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120004225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist