Provider Demographics
NPI:1508495888
Name:BUSBY, SAMANTHA (COTA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BUSBY
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 1:3607 RUNNING M TRL
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79118-8068
Mailing Address - Country:US
Mailing Address - Phone:806-676-3732
Mailing Address - Fax:
Practice Address - Street 1:3607 RUNNING M TRL
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79118-8068
Practice Address - Country:US
Practice Address - Phone:806-676-3732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213205224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant