1083278543 NPI number — SAMANTHA NICOLE ROGOZYNSKI OTD, OTR/L

Table of content: SAMANTHA NICOLE ROGOZYNSKI OTD, OTR/L (NPI 1083278543)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083278543 NPI number — SAMANTHA NICOLE ROGOZYNSKI OTD, OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROGOZYNSKI
Provider First Name:
SAMANTHA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTD, OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083278543
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/27/2022
NPI Reactivation Date:
08/18/2022

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
212 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STEVENSVILLE
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59870-2111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-201-9213
Provider Business Mailing Address Fax Number:
406-215-9002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STEVENSVILLE
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59870-2111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-201-9213
Provider Business Practice Location Address Fax Number:
406-215-9002
Provider Enumeration Date:
04/30/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X , with the licence number: OTP-OT-LIC-9458 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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