Provider Demographics
NPI:1588100069
Name:SAMSON, ANGELA GRACE (OTR)
Entity type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:GRACE
Last Name:SAMSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3852 BRINWOOD GATE
Mailing Address - Street 2:
Mailing Address - City:MISSISSAUGA
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L5M 7H2
Mailing Address - Country:CA
Mailing Address - Phone:702-335-3816
Mailing Address - Fax:
Practice Address - Street 1:725 BASQUE WAY STE 3
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-7973
Practice Address - Country:US
Practice Address - Phone:702-335-3816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15-0577225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist