Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 013406 | NY |
N | 225XH1200X | Occupational Therapist - Hand | 013406 | NY |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 013406 | NY |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 013406 | NY |
NPI | 1902165400 |
---|---|
Provider Name | Mrs. Samantha Marie Tartaglia |
First Address | Ronkonkoma, NY 11779-3522 |
Second Address | Ronkonkoma, NY 11779-3522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2012 |
Last Update Date | 03/05/2012 |