Provider Demographics
NPI:1184955544
Name:JEAN-LOUIS, SAMIRA PHILOMENE
Entity type:Individual
Prefix:
First Name:SAMIRA
Middle Name:PHILOMENE
Last Name:JEAN-LOUIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 NE 173RD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-1735
Mailing Address - Country:US
Mailing Address - Phone:786-344-4225
Mailing Address - Fax:305-650-9140
Practice Address - Street 1:140 NE 173RD STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33162
Practice Address - Country:US
Practice Address - Phone:786-344-4225
Practice Address - Fax:305-650-9104
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12343225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist