Provider Demographics
NPI:1487415527
Name:GO, SAMANTHA GWAIN (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA GWAIN
Middle Name:
Last Name:GO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 UNIONPORT RD APT 1D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-7821
Mailing Address - Country:US
Mailing Address - Phone:551-899-0584
Mailing Address - Fax:
Practice Address - Street 1:575 8TH AVE FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-3158
Practice Address - Country:US
Practice Address - Phone:551-899-0584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027819-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist