Provider Demographics
NPI:1972201200
Name:LEWIS, SAMUEL (OTR/L)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 AUSTIN DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-4538
Mailing Address - Country:US
Mailing Address - Phone:603-969-3055
Mailing Address - Fax:
Practice Address - Street 1:40 CHESTNUT ST STE 3
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3335
Practice Address - Country:US
Practice Address - Phone:603-969-3055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAOTL13354225X00000X
NHEL594225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist