Samantha Grace Nelson

Individual provider Active NPI Occupational Therapy Assistant · Medina, NY

NPI 1164192514 · NPPES record last updated Sep 16, 2021

Key facts

NPI
1164192514
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
450594 (NY)
Practice address
200 Ohio St
Medina, NY 14103-1063
Phone
(585) 798-2000
NPI assigned
Sep 16, 2021
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
450594NYMDOccupational Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 450594 NY Yes

Addresses

Primary practice location

200 Ohio St
Medina, NY 14103-1063

Mailing address

3213 Lower Mountain Rd
Sanborn, NY 14132-9427
Phone (716) 377-0053

Electronic endpoints

TypeEndpointUseAffiliation
CONNECT URL url Health Information Exchange (HIE)

Other providers in Medina, NY

All providers in Medina, NY · Occupational Therapy Assistant in New York

Sources for this page

Verify at the official NPI Registry.