Provider Demographics
NPI:1427606037
Name:COHN, SAMANTHA LEE (OTA)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:LEE
Last Name:COHN
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:LEE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1287 38TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-2256
Mailing Address - Country:US
Mailing Address - Phone:407-230-7724
Mailing Address - Fax:
Practice Address - Street 1:610 E BELLA VISTA ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3008
Practice Address - Country:US
Practice Address - Phone:863-688-8591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5022224Z00000X
FL12243224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty