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General NPI Number Information
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NPI Number | 1679588966
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Entity Type | Individual
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Provider Name | MATTHEW ZACH SAMONTE OTRL
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Gender | Male
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 4500 STUART ST MACH-OCCUPATIONAL THERAPY
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City | COLUMBIA
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State | SC
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Zip | 29207-5700
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Country | US
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Telephone | 803-751-2377
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Fax |
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Provider Business Mailing Address
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Address Line | 1270 POLO RD APT. 835
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City | COLUMBIA
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State | SC
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Zip | 29223-8155
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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 | 111539
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License Number State | TX
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