Provider Demographics
NPI:1124818794
Name:SAMUELS, DELISA (OTR)
Entity type:Individual
Prefix:
First Name:DELISA
Middle Name:
Last Name:SAMUELS
Suffix:
Gender:
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S ROSE ST
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-3859
Mailing Address - Country:US
Mailing Address - Phone:409-939-4068
Mailing Address - Fax:
Practice Address - Street 1:230 S ROSE ST
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-3859
Practice Address - Country:US
Practice Address - Phone:409-939-4068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114715225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist