MEDICARE: SAMANTHA MARIE HAYES OTD, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0019X	Physical Rehabilitation Occupational Therapist	25206	CA

General Provider Information

NPI Number	:	1588342935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA MARIE HAYES OTD, OTR/L

Provider Business Mailing Address
First Line	:	2015 17TH ST APT 1
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95818-1583
Country	:	US
Telephone Number	:	317-690-8493
Fax Number	:

Provider Business Practice Location Address
First Line	:	7334 PARK CITY DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831-3865
Country	:	US
Telephone Number	:	916-393-9026
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2023
Last Update Date	:	07/06/2023

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