Individual provider Active NPI

Keyara Samuel

  • Developmental Therapist
  • Lincolnton, NC
National Provider Identifier
1710480470
Registry record updated May 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental TherapistTaxonomy code 222Q00000X
Practice address
1104 S Aspen St
Lincolnton, NC 28092-3112
Phone
(980) 895-1037
NPI assigned
Mar 8, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental Therapist 222Q00000X Primary

Addresses

Primary practice location

1104 S Aspen St
Lincolnton, NC 28092-3112

Mailing address

321 Fortune Blvd
Milford, MA 01757-1750
Phone (508) 478-0207

Other practice location 1

321 Fortune Blvd
Milford, MA 01757-1750
Phone (508) 478-0207

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": "1520467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746403200000",
    "number": "1710480470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 FORTUNE BLVD",
            "city": "MILFORD",
            "state": "MA",
            "postal_code": "017571750",
            "telephone_number": "508-478-0207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 S ASPEN ST",
            "city": "LINCOLNTON",
            "state": "NC",
            "postal_code": "280923112",
            "telephone_number": "980-895-1037"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "321 Fortune Blvd",
            "address_purpose": "LOCATION",
            "city": "Milford",
            "state": "MA",
            "postal_code": "017571750",
            "country_code": "US",
            "telephone_number": "508-478-0207",
            "fax_number": "508-634-6984",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMUEL",
        "first_name": "KEYARA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-08",
        "last_updated": "2025-05-05",
        "certification_date": "2025-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincolnton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 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.

Verify at the official NPI Registry.