Basic Information
| Provider Information | |||||||||
| NPI: | 1669403598 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAMANTARAY | ||||||||
| FirstName: | HIMANSHU | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | OTR/L, CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4601 MARY ANN CIR | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731504426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053437206 | ||||||||
| FaxNumber: | 9182599521 | ||||||||
| Practice Location | |||||||||
| Address1: | 921 NE 13TH ST | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731045007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054564136 | ||||||||
| FaxNumber: | 4054561734 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 09/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | 829 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
| ID | Type | State | Issuer | Description | 100649730A | 05 | OK | MEDICAID |