Provider Demographics
NPI:1649620923
Name:HONER, SAMANTHA DOROTHY-NICOLE (CMT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DOROTHY-NICOLE
Last Name:HONER
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 W CENTER STREET PROMENADE
Mailing Address - Street 2:UNIT 210
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-3782
Mailing Address - Country:US
Mailing Address - Phone:949-370-1818
Mailing Address - Fax:
Practice Address - Street 1:435 W CENTER STREET PROMENADE
Practice Address - Street 2:UNIT 210
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-3782
Practice Address - Country:US
Practice Address - Phone:949-370-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17907225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist