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General NPI Number Information
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NPI Number | 1962149922
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Entity Type | Individual
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Provider Name | SAMANTHA HARRIS
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Gender | Female
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Dates
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Enumeration Date | 05/19/2022
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 1650 NW 128TH DR
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City | SUNRISE
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State | FL
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Zip | 33323-5206
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Country | US
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Telephone | 954-347-9573
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 245471
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-0107
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 18961
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License Number State | FL
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