Provider Demographics
| NPI: | 1093154981 |
|---|---|
| Name: | PLEASANT WASHINGTON, SAMANTHA BRIANNA (MSOT, OTR/L) |
| Entity Type: | Individual |
| Prefix: | MISS |
| First Name: | SAMANTHA |
| Middle Name: | BRIANNA |
| Last Name: | PLEASANT WASHINGTON |
| Suffix: | |
| Gender: | F |
| Credentials: | MSOT, OTR/L |
| Other - Prefix: | |
| Other - First Name: | |
| Other - Middle Name: | |
| Other - Last Name: | |
| Other - Suffix: | |
| Other - Last Name Type: | |
| Other - Credentials: | |
| Mailing Address - Street 1: | 812 MURROW CT |
| Mailing Address - Street 2: | |
| Mailing Address - City: | FAIRBURN |
| Mailing Address - State: | GA |
| Mailing Address - Zip Code: | 30213-4607 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 770-407-9034 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 812 MURROW CT |
| Practice Address - Street 2: | |
| Practice Address - City: | FAIRBURN |
| Practice Address - State: | GA |
| Practice Address - Zip Code: | 30213-4607 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 770-407-9034 |
| Practice Address - Fax: | |
| Is Sole Proprietor?: | Yes |
| Enumeration Date: | 2013-06-24 |
| Last Update Date: | 2020-10-25 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| GA | OTA001512 | 224Z00000X, 224ZL0004X, 224ZE0001X, 224ZF0002X, 224ZR0403X |
| GA | OT007661 | 225X00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Single Specialty | |
| No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | ||
| No | 224ZL0004X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Low Vision | Group - Single Specialty |
| No | 224ZE0001X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Environmental Modification | |
| No | 224ZF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Feeding, Eating & Swallowing | |
| No | 224ZR0403X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Driving and Community Mobility |
