Provider Demographics
NPI:1326592072
Name:ADAMS, SAMANTHA (OTR/L)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:ADAMS
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 1:1004 KINGS BOTTOM DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-7601
Mailing Address - Country:US
Mailing Address - Phone:803-322-2245
Mailing Address - Fax:
Practice Address - Street 1:1624 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2818
Practice Address - Country:US
Practice Address - Phone:803-454-0364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2664225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist