Provider Demographics
NPI:1457191835
Name:TSE, SAMANTHA ELIZABETH (MS, OTR/L)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:ELIZABETH
Last Name:TSE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 KISWICK ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-5413
Mailing Address - Country:US
Mailing Address - Phone:917-588-8784
Mailing Address - Fax:
Practice Address - Street 1:288 KISSEL AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1621
Practice Address - Country:US
Practice Address - Phone:718-818-2318
Practice Address - Fax:718-818-1666
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028678225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist