Provider Demographics
NPI:1346892197
Name:ARNDTS, SAMANTHA GRACE (COTA/L)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:GRACE
Last Name:ARNDTS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 POWELL LN
Mailing Address - Street 2:
Mailing Address - City:TEN MILE
Mailing Address - State:TN
Mailing Address - Zip Code:37880-5206
Mailing Address - Country:US
Mailing Address - Phone:937-902-7918
Mailing Address - Fax:
Practice Address - Street 1:465 ISBILL RD
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37354-2112
Practice Address - Country:US
Practice Address - Phone:423-442-3990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3282224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant