Active NPI
Stacey-Ann Samuels Taylor, COTA
- Contractor
National Provider Identifier
1912301409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- OTA13010
- Practice address
- 6608 Camden Bay Drive
# 303
Tampa, TAMPA 33635
UM - Phone
- (860) 913-6824
- NPI assigned
- Oct 13, 2014
- 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 |
|---|---|---|---|---|
| Contractor | 171W00000X | OTA13010 | FL | Primary |
Addresses
Primary practice location
6608 Camden Bay Drive
# 303
Tampa, TAMPA 33635
UM
Mailing address
6608 Camden Bay Dr
# 303
Tampa, FL 33635-9084
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTA13010 | FL | MD | Contractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| S & R Assisted Living Facility LLC | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Assisted Living Facility
- Brandon, FL
- NPI 1669148326
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1413158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1413158400000",
"number": "1912301409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6608 CAMDEN BAY DR",
"address_2": "# 303",
"city": "TAMPA",
"state": "FL",
"postal_code": "336359084"
},
{
"country_code": "UM",
"country_name": "United States Minor Outlying Islands",
"address_purpose": "LOCATION",
"address_type": "FGN",
"address_1": "6608 CAMDEN BAY DRIVE",
"address_2": "# 303",
"city": "TAMPA",
"state": "TAMPA",
"postal_code": "33635",
"telephone_number": "860-913-6824"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMUELS TAYLOR",
"first_name": "STACEY-ANN",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-10-13",
"last_updated": "2014-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "FL",
"license": "OTA13010",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.