Provider Demographics
NPI:1639726425
Name:DIPAOLO, SAMANTHA LYNN (OTR/L, OTD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LYNN
Last Name:DIPAOLO
Suffix:
Gender:F
Credentials:OTR/L, OTD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:LYNN
Other - Last Name:TENEYCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L, OTD
Mailing Address - Street 1:4602 CUMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-2412
Mailing Address - Country:US
Mailing Address - Phone:910-423-5622
Mailing Address - Fax:910-423-5538
Practice Address - Street 1:1555 CAIN RD STE 200
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-3076
Practice Address - Country:US
Practice Address - Phone:910-822-3490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12674225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist