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General NPI Number Information
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NPI Number | 1437451317
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Entity Type | Individual
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Provider Name | SAMUEL KIBE WAMBUI OCCUPATIONAL THERAPI
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Gender | Male
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Dates
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Enumeration Date | 11/25/2010
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Last Update Date | 06/17/2013
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Provider Practice Location Address
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Address Line | 14450 SMOKETOWN RD
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City | WOODBRIDGE
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State | VA
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Zip | 22192-4712
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Country | US
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Telephone | 703-576-1383
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Fax |
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Provider Business Mailing Address
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Address Line | 3700 FETTLER PARK DUMFRIES HEALTH CENTER
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City | DUMFRIES
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State | VA
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Zip | 22025
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Country | US
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Telephone | 703-441-7500
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Fax | 301-388-0725
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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 | OT 0672
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License Number State | DC
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