Provider Demographics
NPI:1710795497
Name:BLAIR, SAMANTHA JANE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JANE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 AUGUSTA ST
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:OH
Mailing Address - Zip Code:45157-1204
Mailing Address - Country:US
Mailing Address - Phone:513-349-4722
Mailing Address - Fax:
Practice Address - Street 1:2203 FULTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-2504
Practice Address - Country:US
Practice Address - Phone:513-713-1501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator