Provider Demographics
NPI:1497144687
Name:WOODS, SAMANTHA M (COTA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:M
Last Name:WOODS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 WESTRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3307
Mailing Address - Country:US
Mailing Address - Phone:307-215-6694
Mailing Address - Fax:
Practice Address - Street 1:455 THELMA DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2324
Practice Address - Country:US
Practice Address - Phone:307-472-3327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1028224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant