Provider Demographics
NPI:1679615546
Name:ST. HILAIRE, SAMARRA (OTR)
Entity type:Individual
Prefix:MRS
First Name:SAMARRA
Middle Name:
Last Name:ST. HILAIRE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:SAMARRA
Other - Middle Name:
Other - Last Name:ST. HILAIRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:2027 FLORIDA SOAPBERRY BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7343
Mailing Address - Country:US
Mailing Address - Phone:407-574-5043
Mailing Address - Fax:
Practice Address - Street 1:2027 FLORIDA SOAPBERRY BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7343
Practice Address - Country:US
Practice Address - Phone:407-625-4532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12185225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist