Active NPI
Nancy L Samuelson, OT
- Occupational Therapist
- Lake Preston, SD
National Provider Identifier
1124213939
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 0042
- Practice address
- 703 4TH St SE
Lake Preston, SD 57249-2116 - Phone
- (605) 847-4405
- NPI assigned
- Sep 14, 2007
- Last updated
- Sep 14, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 0042 | SD | Primary |
Addresses
Primary practice location
703 4TH St SE
Lake Preston, SD 57249-2116
Mailing address
1800 Ohio Dr
Brookings, SD 57006-2353
Phone (605) 692-7589
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0042 | SD | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kingsbury Memorial Manor | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Skilled Nursing Facility
- Lake Preston, SD
- NPI 1942272349
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189728000000",
"number": "1124213939",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 OHIO DR",
"city": "BROOKINGS",
"state": "SD",
"postal_code": "570062353",
"telephone_number": "605-692-7589"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "703 4TH ST SE",
"city": "LAKE PRESTON",
"state": "SD",
"postal_code": "572492116",
"telephone_number": "605-847-4405"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMUELSON",
"first_name": "NANCY",
"middle_name": "L",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-14",
"last_updated": "2007-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "SD",
"license": "0042",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Preston, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.