Provider Demographics
NPI:1669403598
Name:SAMANTARAY, HIMANSHU S (OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:HIMANSHU
Middle Name:S
Last Name:SAMANTARAY
Suffix:
Gender:M
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 MARY ANN CIR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73150-4426
Mailing Address - Country:US
Mailing Address - Phone:405-343-7206
Mailing Address - Fax:918-259-9521
Practice Address - Street 1:921 NE 13TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5007
Practice Address - Country:US
Practice Address - Phone:405-456-4136
Practice Address - Fax:405-456-1734
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK829225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100649730AMedicaid