Provider Demographics
NPI:1649094889
Name:ELIA, SAMANTHA ROSE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ROSE
Last Name:ELIA
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 1:129 BROAD ST APT 2E
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4777
Mailing Address - Country:US
Mailing Address - Phone:914-506-0753
Mailing Address - Fax:
Practice Address - Street 1:122 PALMERS HILL RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2134
Practice Address - Country:US
Practice Address - Phone:203-204-8449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist