Provider Demographics
NPI:1851869929
Name:BLIMLING, SAMANTHA (COTA/L)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BLIMLING
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 MASSEY LN
Mailing Address - Street 2:
Mailing Address - City:MURRAYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62668-8166
Mailing Address - Country:US
Mailing Address - Phone:217-490-0467
Mailing Address - Fax:
Practice Address - Street 1:873 GROVE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-2828
Practice Address - Country:US
Practice Address - Phone:217-479-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.005053224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant