Provider Demographics
NPI:1437842747
Name:WILK, SAMANTHA (OTR/L)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:WILK
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 1:30 SPRING HILL RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2317
Mailing Address - Country:US
Mailing Address - Phone:201-407-4662
Mailing Address - Fax:
Practice Address - Street 1:5 BOROLINE RD
Practice Address - Street 2:
Practice Address - City:SADDLE RIVER
Practice Address - State:NJ
Practice Address - Zip Code:07458-2343
Practice Address - Country:US
Practice Address - Phone:864-253-3590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01102200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist