Lisa Andrea Samuelson, OTR

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

114432 Issued in TX

Practice address

4342 15TH Ave S Ste 105
Fargo, ND 58103-1125

Phone

(701) 936-9495

Fax

(952) 222-1994

NPI assigned

Aug 17, 2018

Sex

Female

Sole proprietor

Yes

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

Enrolled in ND

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Embrace Therapy Services

  • Multi-Specialty Clinic/Center
  • Fargo, ND
  • NPI 1134780349
  Medicare reassignment NPD
• Beyond Boundaries Speech Language Therapy, Inc.

  • Speech-Language Pathologist
  • Fargo, ND
  • NPI 1790999605
  NPD (past)

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

{
    "created_epoch": "1534464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689552000000",
    "number": "1730669995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4342 15TH AVE S STE 105",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031125",
            "telephone_number": "701-936-9495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4342 15TH AVE S STE 105",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031125",
            "telephone_number": "701-936-9495",
            "fax_number": "952-222-1994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUELSON",
        "first_name": "LISA",
        "middle_name": "ANDREA",
        "name_prefix": "Ms.",
        "credential": "OTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-17",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "TX",
            "license": "114432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyle Sample
• Jerome M Sampson, MD
• Pamela Marie Samson, PHD
• Tessa Samson
• Walter Vincent Samuel, D.D.S.
• Paige Rae Samuelson, PT, DPT
• Wayne D Samuelson, PHD
• Mohamed Sanaullah, MD
• Cyd Sanchez
• Sanctuary Massage Therapy Inc.

• Pediatric Occupational Therapist in Fargo, ND
• Providers in Fargo, ND by specialty
• Pediatric Occupational Therapist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.