Provider Demographics
NPI:1902165400
Name:TARTAGLIA, SAMANTHA MARIE (OTR/L, MS)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:MARIE
Last Name:TARTAGLIA
Suffix:
Gender:F
Credentials:OTR/L, MS
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:MARIE
Other - Last Name:CONZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L, MS
Mailing Address - Street 1:192 MAGUA ST
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-3522
Mailing Address - Country:US
Mailing Address - Phone:631-332-1997
Mailing Address - Fax:
Practice Address - Street 1:192 MAGUA ST
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-3522
Practice Address - Country:US
Practice Address - Phone:631-332-1997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013406225X00000X, 225XH1200X, 225XN1300X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation