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NPI Code Detail

MEDICARE: SAMANTHA ROTHMAN

MEDICARE: SAMANTHA ROTHMAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist6020AZ

General Provider Information

NPI Number : 1386164747
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA ROTHMAN
Provider Business Mailing Address
First Line : 4140 N CENTRAL AVE APT 3119
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-1862
Country : US
Telephone Number : 941-276-6961
Fax Number :
Provider Business Practice Location Address
First Line : 18001 N 79TH AVE STE A3
Second Line :
City : GLENDALE
State : AZ
Zip : 85308-8389
Country : US
Telephone Number : 623-979-5266
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2017
Last Update Date : 07/21/2022

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