Nicole Samaroo, MS, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

21862 Issued in FL

Practice address

40851 County Road 669
Decatur, MI 49045-8911

Phone

(917) 312-6973

NPI assigned

Jun 7, 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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Legacy Healthcare Services Inc 3,431 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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.

• Legacy Healthcare Services, Inc

  • Physical Therapist
  • Tampa, FL
  • NPI 1336535988

  FL, Occupational Therapist

  Medicare reassignment NPD
• Legacy Healthcare Services Inc

  • Physical Therapist
  • Cary, NC
  • NPI 1225879489

  Occupational Therapist

  NPD
• Rehabcare Group East, LLC

  • Rehabilitation Clinic/Center
  • Shalimar, FL
  • NPI 1407382278
  NPD (past)

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

{
    "created_epoch": "1623024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623024000000",
    "number": "1770150864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40851 COUNTY ROAD 669",
            "city": "DECATUR",
            "state": "MI",
            "postal_code": "490458911",
            "telephone_number": "917-312-6973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40851 COUNTY ROAD 669",
            "city": "DECATUR",
            "state": "MI",
            "postal_code": "490458911",
            "telephone_number": "917-312-6973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMAROO",
        "first_name": "NICOLE",
        "credential": "MS, OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-07",
        "last_updated": "2021-06-07",
        "certification_date": "2021-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": "21862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Florida",
            "affiliation": "N",
            "address_1": "1902 59th St W Fl 34209",
            "city": "Bradenton",
            "state": "FL",
            "country_code": "US",
            "postal_code": "342094602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Richard Lewis Moussalli, DDS
• Robert Steven Murav, D.D.S.
• Murks Village Market Inc
• Erica Nagra, RN, BSN
• Kailey Noble
• Nicole D Summerton
• Twin Doves II LLC
• Joshua Scott Wahlstrom, MD
• David Joseph Wendling, MD
• Song Yol Yu, D.O.

• All providers in Decatur, MI
• Occupational Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.