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General NPI Number Information
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NPI Number | 1134727159
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Entity Type | Individual
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Provider Name | SAMANTHA OM
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Gender | Female
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Dates
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Enumeration Date | 10/12/2020
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 3210 SEPULVEDA BLVD
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City | TORRANCE
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State | CA
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Zip | 90505-2719
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Country | US
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Telephone | 424-571-2603
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Fax |
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Provider Business Mailing Address
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Address Line | 22409 MADISON ST
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City | TORRANCE
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State | CA
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Zip | 90505-2528
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Country | US
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Telephone | 310-918-0741
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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 | 17592
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License Number State | CA
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