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General NPI Number Information
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NPI Number | 1629380340
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Entity Type | Individual
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Provider Name | THEA SAMIT OTR
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Gender | Female
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Dates
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Enumeration Date | 07/10/2010
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Last Update Date | 07/10/2010
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Provider Practice Location Address
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Address Line | 4151 E. 11 ST.
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City | NEW YORK
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State | NY
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Zip | 33009-1836
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Country | US
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Telephone | 732-247-0161
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Fax | 732-247-2790
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Provider Business Mailing Address
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Address Line | 308 HARRISON AVE
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City | HIGHLAND PARK
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State | NJ
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Zip | 08904-1836
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Country | US
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Telephone | 732-247-0161
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Fax | 732-247-2790
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC04713000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 003816-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT 5124
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License Number State | FL
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