Provider Demographics
NPI:1861802662
Name:MCCABE, SAMANTHA (OTR)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:MCCABE
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 1:2959 MALLORY CIR
Mailing Address - Street 2:APT 4205
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-1842
Mailing Address - Country:US
Mailing Address - Phone:973-234-9165
Mailing Address - Fax:
Practice Address - Street 1:5900 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-2002
Practice Address - Country:US
Practice Address - Phone:973-276-7887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-01
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00580700225X00000X
FL16513225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist