Provider Demographics
NPI:1467186916
Name:KOELMEL, SAMANTHA GIBSON (OTR, OTD, MS)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:GIBSON
Last Name:KOELMEL
Suffix:
Gender:F
Credentials:OTR, OTD, MS
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:GIBSON
Other - Last Name:FARMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR, OTD, MS
Mailing Address - Street 1:6867 FLICK DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-9180
Mailing Address - Country:US
Mailing Address - Phone:260-438-0386
Mailing Address - Fax:
Practice Address - Street 1:118 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3323
Practice Address - Country:US
Practice Address - Phone:317-843-4590
Practice Address - Fax:317-200-3966
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006914A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist