Provider Demographics
NPI:1962843045
Name:SAMUEL, MARY (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 SEABIRD DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-5220
Mailing Address - Country:US
Mailing Address - Phone:718-309-5626
Mailing Address - Fax:
Practice Address - Street 1:147 W 35TH ST
Practice Address - Street 2:SUITE 407
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2110
Practice Address - Country:US
Practice Address - Phone:212-842-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017021-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist