Provider Demographics
NPI:1831870062
Name:POPOVICH, SAMANTHA J (CPHT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:J
Last Name:POPOVICH
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 OXFORD CIR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-4691
Mailing Address - Country:US
Mailing Address - Phone:419-202-3368
Mailing Address - Fax:
Practice Address - Street 1:1162 OXFORD CIR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-4691
Practice Address - Country:US
Practice Address - Phone:419-202-3368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372500000X, 372600000X, 376J00000X
OH09305972183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker