1437451317 NPI number — MR. SAMUEL KIBE WAMBUI OCCUPATIONAL THERAPI

Table of content: MR. SAMUEL KIBE WAMBUI OCCUPATIONAL THERAPI (NPI 1437451317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437451317 NPI number — MR. SAMUEL KIBE WAMBUI OCCUPATIONAL THERAPI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAMBUI
Provider First Name:
SAMUEL
Provider Middle Name:
KIBE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
OCCUPATIONAL THERAPI
Provider Gender Code:
M

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:
1437451317
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3700 FETTLER PARK
Provider Second Line Business Mailing Address:
DUMFRIES HEALTH CENTER
Provider Business Mailing Address City Name:
DUMFRIES
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-441-7500
Provider Business Mailing Address Fax Number:
301-388-0725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14450 SMOKETOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBRIDGE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22192-4712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-576-1383
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/25/2010

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: 225X00000X , with the licence number:  OT 0672 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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