Provider Demographics
NPI:1619133378
Name:PARKER, SAMANTHA MAO
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MAO
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5040 N MARINE DR
Mailing Address - Street 2:A8
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3268
Mailing Address - Country:US
Mailing Address - Phone:773-450-5910
Mailing Address - Fax:
Practice Address - Street 1:5040 N MARINE DR
Practice Address - Street 2:APT A8
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-3268
Practice Address - Country:US
Practice Address - Phone:773-450-5910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist