Provider Demographics
NPI:1255932554
Name:ALTMAN, SAMANTHA A (SLP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:A
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:A
Other - Last Name:KOHLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2550 S STATE ROUTE 100
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-9356
Mailing Address - Country:US
Mailing Address - Phone:419-447-7203
Mailing Address - Fax:
Practice Address - Street 1:1331 E 4TH ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-1505
Practice Address - Country:US
Practice Address - Phone:419-523-9337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND2020145-SP235Z00000X
OHSP.14340235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist