Provider Demographics
NPI:1184435141
Name:SMITH, SAMANTHA EMILY
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:EMILY
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38394 N BURR OAK LN
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60083-9546
Mailing Address - Country:US
Mailing Address - Phone:224-234-2620
Mailing Address - Fax:
Practice Address - Street 1:1424 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-4309
Practice Address - Country:US
Practice Address - Phone:517-312-1712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist