Individual
JO ELLEN TENNYSON-SAMSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
3031 N MAIN ST, SOQUEL, CA 95073-2204
(831) 458-6230
Mailing address
PO BOX 1758, CAPITOLA, CA 95010-1758
(831) 531-8277
(831) 576-7717
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT2254
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09052006467538
—
CA
Enumeration date
10/03/2006
Last updated
05/27/2022
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