Provider Demographics
NPI:1306478326
Name:SAMUEL, JENSINE ANN (OTR/L)
Entity type:Individual
Prefix:
First Name:JENSINE
Middle Name:ANN
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JENSINE
Other - Middle Name:ANN
Other - Last Name:VARUGHESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:814 GRAYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-3716
Mailing Address - Country:US
Mailing Address - Phone:214-235-5635
Mailing Address - Fax:
Practice Address - Street 1:1 DUVALL ST
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3210
Practice Address - Country:US
Practice Address - Phone:215-391-6091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC016624225X00000X
TX121152225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist