Provider Demographics
NPI:1356958854
Name:HAMDAN, SAMY (OTR/L)
Entity type:Individual
Prefix:
First Name:SAMY
Middle Name:
Last Name:HAMDAN
Suffix:
Gender:M
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 1:1900 BLUE OAKS BLVD APT 532
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-8441
Mailing Address - Country:US
Mailing Address - Phone:951-329-0552
Mailing Address - Fax:
Practice Address - Street 1:585 NUT TREE CT
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-3353
Practice Address - Country:US
Practice Address - Phone:707-449-8081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21642225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist