Provider Demographics
NPI:1780293415
Name:GUBKA, SAMANTHA (MS OTR/L)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:GUBKA
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 S SIGNAL BUTTE RD UNIT 16
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-2138
Mailing Address - Country:US
Mailing Address - Phone:480-276-0391
Mailing Address - Fax:
Practice Address - Street 1:1025 N COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3302
Practice Address - Country:US
Practice Address - Phone:480-472-0710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist