Provider Demographics
NPI:1356773451
Name:MEYER, SAMANTHA DIANE (COTA/L)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DIANE
Last Name:MEYER
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 1:234 ATWOOD DR SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-1076
Mailing Address - Country:US
Mailing Address - Phone:319-430-7973
Mailing Address - Fax:
Practice Address - Street 1:234 ATWOOD DR SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-1076
Practice Address - Country:US
Practice Address - Phone:319-430-7973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000901224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant