Healthcare Provider Details

I. General information

NPI: 1083579296
Provider Name (Legal Business Name): SAMUEL CHRISTIAN SEMADENI OTD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 3 BAR N HILL RD
FAIRVIEW WY
83119
US

IV. Provider business mailing address

PO BOX 118
FAIRVIEW WY
83119-0118
US

V. Phone/Fax

Practice location:
  • Phone: 307-248-8471
  • Fax:
Mailing address:
  • Phone: 307-248-8471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-1886
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: