Provider Demographics
NPI:1720752892
Name:KLEIN, SAMANTHA RYAN (MT-BC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RYAN
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 E BASELINE RD APT 2069
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1666
Mailing Address - Country:US
Mailing Address - Phone:517-518-0859
Mailing Address - Fax:
Practice Address - Street 1:577 E BASELINE RD APT 2069
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1666
Practice Address - Country:US
Practice Address - Phone:517-518-0859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
16766225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist