Provider Demographics
NPI:1639624109
Name:GRISHABER, SAMANTHA NICOLE (OTR/L, OTD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:NICOLE
Last Name:GRISHABER
Suffix:
Gender:F
Credentials:OTR/L, OTD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:NICOLE
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 681478
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-1478
Mailing Address - Country:US
Mailing Address - Phone:615-740-9782
Mailing Address - Fax:615-740-8510
Practice Address - Street 1:111 LUTHER RD STE 6
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2112
Practice Address - Country:US
Practice Address - Phone:615-740-9782
Practice Address - Fax:615-740-8510
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT5453225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446631Medicaid