Individual
MOISES ALEXANDER SAMANIEGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
28 WILDWOOD LN, SELKIRK, NY 12158-1230
(518) 894-3592
Mailing address
28 WILDWOOD LN, SELKIRK, NY 12158-1230
(518) 894-3592
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
011282
NY
224Z00000X
Occupational Therapy Assistant
113720-01
NY
Other
Enumeration date
01/06/2022
Last updated
01/09/2023
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