Provider Demographics
NPI:1558765461
Name:FARAGO, SAMANTHA (ATC, LAT, CSNC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:FARAGO
Suffix:
Gender:F
Credentials:ATC, LAT, CSNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FRIENDSHIP DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04351-3330
Mailing Address - Country:US
Mailing Address - Phone:207-215-6982
Mailing Address - Fax:
Practice Address - Street 1:16 FRIENDSHIP DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:ME
Practice Address - Zip Code:04351-3330
Practice Address - Country:US
Practice Address - Phone:207-215-6982
Practice Address - Fax:207-215-6982
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2025-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT5342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer