Basic Information
| Provider Information | |||||||||
| NPI: | 1437451317 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WAMBUI | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | KIBE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | OCCUPATIONAL THERAPI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3700 FETTLER PARK | ||||||||
| Address2: | DUMFRIES HEALTH CENTER | ||||||||
| City: | DUMFRIES | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034417500 | ||||||||
| FaxNumber: | 3013880725 | ||||||||
| Practice Location | |||||||||
| Address1: | 14450 SMOKETOWN RD | ||||||||
| Address2: | |||||||||
| City: | WOODBRIDGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221924712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035761383 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2010 | ||||||||
| LastUpdateDate: | 06/17/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT 0672 | DC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.