Provider Demographics
NPI:1942760277
Name:PUGH, SAMANTHA FAE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:FAE
Last Name:PUGH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 BENDEMEER LN
Mailing Address - Street 2:
Mailing Address - City:ROLESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27571-9731
Mailing Address - Country:US
Mailing Address - Phone:919-673-4246
Mailing Address - Fax:919-263-9605
Practice Address - Street 1:200 DR. CALVIN JONES HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-673-4246
Practice Address - Fax:919-263-9605
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12021225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty