Provider Demographics
NPI:1417745274
Name:IODICE, SAMANTHA (OTD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:IODICE
Suffix:
Gender:
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 HAVERSTRAW RD
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-2512
Mailing Address - Country:US
Mailing Address - Phone:845-521-0746
Mailing Address - Fax:
Practice Address - Street 1:834 HAVERSTRAW RD
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-2512
Practice Address - Country:US
Practice Address - Phone:845-521-0746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025562225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics