Provider Demographics
NPI:1942975545
Name:ABRAHAM, SAMUEL (OTR)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:MR
Other - First Name:SUNNY
Other - Middle Name:
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6735 HEMPSTEAD CT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-5313
Mailing Address - Country:US
Mailing Address - Phone:870-329-4117
Mailing Address - Fax:
Practice Address - Street 1:6735 HEMPSTEAD CT
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-5313
Practice Address - Country:US
Practice Address - Phone:870-329-4117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006379225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist