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General NPI Number Information
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NPI Number | 1093015570
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Entity Type | Individual
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Provider Name | NICOLE D SAMUEL OT
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Gender | Female
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Dates
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Enumeration Date | 10/29/2010
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 400 N ERIE HWY
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City | HAMILTON
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State | OH
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Zip | 45011-4263
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Country | US
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Telephone | 513-887-3710
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Fax | 360-425-1053
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Provider Business Mailing Address
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Address Line | 375 AMAZON AVE
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City | CINCINNATI
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State | OH
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Zip | 45220-1148
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Country | US
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Telephone | 815-822-4592
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 274950
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License Number State | OR
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | OT60189012
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License Number State | WA
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