Provider Demographics
NPI:1558066951
Name:GARRO, SAMANTHA SUE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:SUE
Last Name:GARRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 HOLCOMB AVE
Mailing Address - Street 2:
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-1151
Mailing Address - Country:US
Mailing Address - Phone:330-690-1474
Mailing Address - Fax:
Practice Address - Street 1:105 EXECUTIVE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-1692
Practice Address - Country:US
Practice Address - Phone:330-655-0946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA007948224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant