Healthcare Provider Details

I. General information

NPI: 1558569152
Provider Name (Legal Business Name): SAMANTHA MARIE TONEY OT CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 JAMES CASEY ST SUITE 3C
AUSTIN TX
78745
US

IV. Provider business mailing address

PO BOX 42680
AUSTIN TX
78704-0043
US

V. Phone/Fax

Practice location:
  • Phone: 512-441-6008
  • Fax: 512-326-2805
Mailing address:
  • Phone: 512-441-6008
  • Fax: 512-326-2805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number112327
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number112327
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: