Individual
MS. LISA ANDREA SAMUELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
4342 15TH AVE S STE 105, FARGO, ND 58103-1125
(701) 936-9495
(952) 222-1994
Mailing address
4342 15TH AVE S STE 105, FARGO, ND 58103-1125
(701) 936-9495
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
114432
TX
Other
Enumeration date
08/17/2018
Last updated
07/17/2023
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