Samantha Kathryn Polak, MS, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

21013 Issued in CA

Practice address

9520 Padgett St Ste 104
San Diego, CA 92126-4446

Phone

(858) 866-8133

NPI assigned

Sep 15, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Blast Off Children'S Therapy Services, Inc.

  • Clinic/Center
  • San Diego, CA
  • NPI 1518390616
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631664000000",
    "number": "1700556305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4944 NARRAGANSETT AVE APT 14",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921076121",
            "telephone_number": "908-309-4941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9520 PADGETT ST STE 104",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921264446",
            "telephone_number": "858-866-8133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLAK",
        "first_name": "SAMANTHA",
        "middle_name": "KATHRYN",
        "name_prefix": "Ms.",
        "credential": "MS, OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-15",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CA",
            "license": "21013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Parvathi Koka Pokala, DDS
• Sathya Pratap Pokala, M.D.
• Poke-Aha-Ntas Acupuncture, a Professional Corporation
• Bhupesh Pokhrel, MD
• Rebecca Krista Polacek, RD
• Hannah Polakov
• Indira Ann Polan, OT
• Karyme Polanco
• Marcela Polanco
• Myesha Poland

• Occupational Therapist in San Diego, CA
• Providers in San Diego, CA by specialty
• Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.