Provider Demographics
NPI:1619376159
Name:BECKER, SAMANTHA CALLYN (OT)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:CALLYN
Last Name:BECKER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:CALLYN
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:41680 MISS BESSIE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2906
Mailing Address - Country:US
Mailing Address - Phone:240-256-3711
Mailing Address - Fax:240-256-3612
Practice Address - Street 1:41680 MISS BESSIE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2906
Practice Address - Country:US
Practice Address - Phone:240-256-3711
Practice Address - Fax:240-256-3612
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06189225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist