Provider Demographics
NPI:1477231645
Name:LAY, SAMANTHA ELIZABETH (MOT)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:ELIZABETH
Last Name:LAY
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:ELIZABETH
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT
Mailing Address - Street 1:7738 SHARPSHOOTERS CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20111-8233
Mailing Address - Country:US
Mailing Address - Phone:703-473-3111
Mailing Address - Fax:
Practice Address - Street 1:9852 FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-3176
Practice Address - Country:US
Practice Address - Phone:919-424-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006069225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist