Individual
KEISHA SAMUEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
776 S 18TH ST FL 2, NEWARK, NJ 07103-1050
(201) 878-2598
Mailing address
776 S 18TH ST FL 2, NEWARK, NJ 07103-1050
(201) 878-2598
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
009963
NY
Other
Enumeration date
11/22/2019
Last updated
11/22/2019
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