Provider Demographics
NPI:1992062780
Name:BOYETT, SAMANTHA G (OTA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:G
Last Name:BOYETT
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 120547
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34712-0547
Mailing Address - Country:US
Mailing Address - Phone:352-394-0212
Mailing Address - Fax:352-241-6361
Practice Address - Street 1:405 S SEMINOLE AVE
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-5520
Practice Address - Country:US
Practice Address - Phone:352-394-0212
Practice Address - Fax:353-241-6361
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA11516224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant