Provider Demographics
NPI:1932778180
Name:SILVA, SAMANTHA BETH
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:BETH
Last Name:SILVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 MCVEY AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-4606
Mailing Address - Country:US
Mailing Address - Phone:407-227-7382
Mailing Address - Fax:
Practice Address - Street 1:667 MCVEY AVE APT 305
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-4606
Practice Address - Country:US
Practice Address - Phone:407-227-7382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26182225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist