Healthcare Provider Details

I. General information

NPI: 1134536337
Provider Name (Legal Business Name): SAMANTHA ERIN KOGLER OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2014
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16968 W BELL RD # D401
SURPRISE AZ
85374-8943
US

IV. Provider business mailing address

9097 E DESERT COVE AVE STE 110
SCOTTSDALE AZ
85260-6276
US

V. Phone/Fax

Practice location:
  • Phone: 623-299-9190
  • Fax: 623-299-9191
Mailing address:
  • Phone: 602-329-8250
  • Fax: 480-565-1898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: