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General NPI Number Information
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NPI Number | 1295482172
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Entity Type | Individual
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Provider Name | SAMANTHA HUMPHREY MS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 03/09/2022
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 100 HIGH POINT DR
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City | MEDINA
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State | OH
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Zip | 44256-4360
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Country | US
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Telephone | 330-723-0110
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Fax |
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Provider Business Mailing Address
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Address Line | 600 E GRANGER RD
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City | BROOKLYN HEIGHTS
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State | OH
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Zip | 44131-6704
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Country | US
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Telephone | 440-250-1840
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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 | 007055
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License Number State | OH
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