Provider Demographics
NPI:1730644089
Name:PUCCI, SAMANTHA SILVIA (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:SILVIA
Last Name:PUCCI
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 ERIE ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-7349
Mailing Address - Country:US
Mailing Address - Phone:773-851-0581
Mailing Address - Fax:
Practice Address - Street 1:2156 DEEP WATER LN STE 110
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8507
Practice Address - Country:US
Practice Address - Phone:630-904-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.012858225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist