Provider Demographics
NPI:1417564030
Name:MACCALLUM, SAMANTHA (OTR)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:MACCALLUM
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W CASCADE WAY
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6017
Mailing Address - Country:US
Mailing Address - Phone:509-624-3115
Mailing Address - Fax:
Practice Address - Street 1:123 W CASCADE WAY
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6017
Practice Address - Country:US
Practice Address - Phone:509-624-3115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60924416225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOT60924416OtherOCCUPATIONAL THERAPIST LICENSE