Provider Demographics
NPI:1134712128
Name:ROBERTS, SAMANTHA JO (COTA/L)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 WILLIAM PENN PL APT 1611
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-6924
Mailing Address - Country:US
Mailing Address - Phone:724-914-0406
Mailing Address - Fax:
Practice Address - Street 1:2224 WALTERS RD
Practice Address - Street 2:
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101-3480
Practice Address - Country:US
Practice Address - Phone:412-903-3176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP008267224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant