Healthcare Provider Details

I. General information

NPI: 1982022372
Provider Name (Legal Business Name): SAMANTHA KIRSCHNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 WESTON RD SUITE 200
WESTON FL
33326-1976
US

IV. Provider business mailing address

2881 SOUTH CAMBRIDGE LANE
COOPER CITY FL
33026
US

V. Phone/Fax

Practice location:
  • Phone: 954-349-2922
  • Fax:
Mailing address:
  • Phone: 248-535-6785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 16269
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: