Healthcare Provider Details

I. General information

NPI: 1336043777
Provider Name (Legal Business Name): SAMANTHA ANN KIMMEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 NEW HYDE PARK RD
FRANKLIN SQUARE NY
11010-3045
US

IV. Provider business mailing address

46 ROOSEVELT AVE APT B
EAST NORTHPORT NY
11731-1151
US

V. Phone/Fax

Practice location:
  • Phone: 516-616-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: