Provider Demographics
NPI:1972321867
Name:KIRSCH, SAMANTHA
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:KIRSCH
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 1:8 RULE DR
Mailing Address - Street 2:
Mailing Address - City:ARCADE
Mailing Address - State:NY
Mailing Address - Zip Code:14009-1019
Mailing Address - Country:US
Mailing Address - Phone:716-491-9943
Mailing Address - Fax:
Practice Address - Street 1:8 RULE DR
Practice Address - Street 2:
Practice Address - City:ARCADE
Practice Address - State:NY
Practice Address - Zip Code:14009-1019
Practice Address - Country:US
Practice Address - Phone:716-491-9943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029543225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist