Provider Demographics
NPI:1689934200
Name:MCLEMORE, SAMANTHA KAY (DPT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KAY
Last Name:MCLEMORE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 N COURT AVE
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-2426
Mailing Address - Country:US
Mailing Address - Phone:785-443-0124
Mailing Address - Fax:
Practice Address - Street 1:211 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:KS
Practice Address - Zip Code:67748-1201
Practice Address - Country:US
Practice Address - Phone:785-672-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04372174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist