Active NPI
Princy Susan Samuel
- Pediatric Occupational Therapist
- Edmond, OK
National Provider Identifier
1255140752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 5909
- Practice address
- 14715 Bristol Park Blvd
Edmond, OK 73013-1894 - Phone
- (405) 840-1686
- NPI assigned
- Dec 31, 2024
- 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 |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 5909 | OK | Primary |
Addresses
Primary practice location
14715 Bristol Park Blvd
Edmond, OK 73013-1894
Mailing address
3413 Sugar Maple Way
Oklahoma City, OK 73179-1300
Phone (405) 650-1546
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1735603200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1735862400000",
"number": "1255140752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3413 SUGAR MAPLE WAY",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731791300",
"telephone_number": "405-650-1546"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14715 BRISTOL PARK BLVD",
"city": "EDMOND",
"state": "OK",
"postal_code": "730131894",
"telephone_number": "405-840-1686"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMUEL",
"first_name": "PRINCY",
"middle_name": "SUSAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-12-31",
"last_updated": "2025-01-03",
"certification_date": "2025-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "OK",
"license": "5909",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edmond, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.