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NPI 1447760632

NPI 1447760632 : SAMANTHA ADAIR MS, OTR/L, DPT : CULVER CITY, CA

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General NPI Number Information
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    NPI Number           |    1447760632
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    Entity Type          |    Individual 
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    Provider Name        |    SAMANTHA ADAIR MS, OTR/L, DPT
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    10/03/2017
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    Last Update Date     |    10/07/2017
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Provider Practice Location Address
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    Address Line         |    6820 S CENTINELA AVE 
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    City                 |    CULVER CITY
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    State                |    CA
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    Zip                  |    90230-6301
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    Country              |    US
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    Telephone            |    310-337-7115
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    105 VIA BAJA 
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    City                 |    VENTURA
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    State                |    CA
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    Zip                  |    93003-1232
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    Country              |    US
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    Telephone            |    
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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       |    16374
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    License Number State |    CA
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