Provider Demographics
NPI:1467046938
Name:CARRINGTON, SAMUEL MARK (OTR)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:MARK
Last Name:CARRINGTON
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BIRCH HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1886
Mailing Address - Country:US
Mailing Address - Phone:731-549-6708
Mailing Address - Fax:
Practice Address - Street 1:22 BIRCH HOLLOW LN
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1886
Practice Address - Country:US
Practice Address - Phone:731-549-6708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6767225X00000X
VT072.0134172225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist