Provider Demographics
NPI:1144568916
Name:WAYLAND, SAMANTHA (BA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:WAYLAND
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11212 N MAY AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-6335
Mailing Address - Country:US
Mailing Address - Phone:405-708-6331
Mailing Address - Fax:405-708-6331
Practice Address - Street 1:11212 N MAY AVE STE 208
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-6335
Practice Address - Country:US
Practice Address - Phone:405-708-6331
Practice Address - Fax:405-708-6331
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor