Provider Demographics
NPI:1710401963
Name:CHAMBERLAIN, SAMANTHA L (PT, DPT, CERT-MMOA)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:L
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:PT, DPT, CERT-MMOA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2096 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:OK
Mailing Address - Zip Code:74346-3876
Mailing Address - Country:US
Mailing Address - Phone:918-281-9521
Mailing Address - Fax:877-912-0432
Practice Address - Street 1:21 E 3RD ST
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-7034
Practice Address - Country:US
Practice Address - Phone:918-791-8789
Practice Address - Fax:877-912-0432
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5349225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist