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General NPI Number Information
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NPI Number | 1598586505
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Entity Type | Individual
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Provider Name | SAMANTHA NICOLE TONGOL SANTIAGO OTR/L
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Gender | Female
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Dates
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Enumeration Date | 10/22/2024
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 8826 S EASTERN AVE STE 115
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City | LAS VEGAS
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State | NV
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Zip | 89123-4826
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Country | US
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Telephone | 702-360-1137
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Fax |
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Provider Business Mailing Address
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Address Line | 451 HORIZON COVE PL
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City | HENDERSON
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State | NV
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Zip | 89002-8461
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Country | US
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Telephone | 702-344-9325
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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 | OT-3559
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License Number State | NV
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