Provider Demographics
NPI:1730957010
Name:BIRES, SAMANTHA (OTR)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BIRES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 KIRKS MILL RD
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19362-9030
Mailing Address - Country:US
Mailing Address - Phone:215-206-7486
Mailing Address - Fax:
Practice Address - Street 1:253 KIRKS MILL RD
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:PA
Practice Address - Zip Code:19362-9030
Practice Address - Country:US
Practice Address - Phone:215-206-7486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC013555225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist