=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538732367
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMANTHA FRAILEY MS OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2021
-----------------------------------------------------
Last Update Date | 07/20/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 HIGH AVE
-----------------------------------------------------
City | ENDICOTT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13760-4789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-786-7300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 NEW YORK AVE
-----------------------------------------------------
City | HALLSTEAD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18822-9353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-396-4233
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 024441-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------