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General NPI Number Information
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NPI Number | 1013400274
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Entity Type | Individual
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Provider Name | SAMANTHA FULP
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Gender | Female
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 04/06/2019
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Provider Practice Location Address
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Address Line | 101 T ST NE
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City | WASHINGTON
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State | DC
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Zip | 20002-1519
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Country | US
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Telephone | 956-278-0770
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Fax |
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Provider Business Mailing Address
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Address Line | 11001 W 120TH AVE STE 310
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City | BROOMFIELD
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State | CO
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Zip | 80021-3493
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Country | US
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Telephone | 956-278-0770
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 119196
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT010001539
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License Number State | DC
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