Provider Demographics
NPI:1700132313
Name:JADLOWSKI, SAMANTHA ANN (OT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ANN
Last Name:JADLOWSKI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:SANDILAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 34669
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-0669
Mailing Address - Country:US
Mailing Address - Phone:402-932-6791
Mailing Address - Fax:402-614-7485
Practice Address - Street 1:8419 S 73RD PLZ STE 104
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-1507
Practice Address - Country:US
Practice Address - Phone:402-991-2745
Practice Address - Fax:402-991-2748
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1660225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025941100Medicaid