MEDICARE: KRISTINA SAMPSEL, MOTR/L, S-CORP

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
1	225XP0200X	Pediatric Occupational Therapist	2262	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902179021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRISTINA SAMPSEL, MOTR/L, S-CORP

Provider Business Mailing Address
First Line	:	1849 CALLE LOS VECINOS NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-2805
Country	:	US
Telephone Number	:	505-321-7804
Fax Number	:

Provider Business Practice Location Address
First Line	:	1849 CALLE LOS VECINOS NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-2805
Country	:	US
Telephone Number	:	505-321-7804
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS KRISTINA M SAMPSEL
Credential	:	MOTR/L
Telephone Number	:	505-321-7804

Provider Enumeration Date	:	02/21/2012
Last Update Date	:	02/21/2012

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