Provider Demographics
NPI:1093468282
Name:CAMERON, SAMANTHA JO (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:JO
Last Name:CAMERON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3319 WALNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:DIX
Mailing Address - State:IL
Mailing Address - Zip Code:62830-1001
Mailing Address - Country:US
Mailing Address - Phone:618-780-9711
Mailing Address - Fax:
Practice Address - Street 1:3319 WALNUT HILL RD
Practice Address - Street 2:
Practice Address - City:DIX
Practice Address - State:IL
Practice Address - Zip Code:62830-1001
Practice Address - Country:US
Practice Address - Phone:618-780-9711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.014696225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist