Provider Demographics
NPI:1750627113
Name:OFFUTT, SAMANTHA CHRISTINE (OTR/L)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:CHRISTINE
Last Name:OFFUTT
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 1:607 ADMIRAL DRIVE
Mailing Address - Street 2:UNIT 104
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:443-745-0926
Mailing Address - Fax:
Practice Address - Street 1:607 ADMIRAL DR
Practice Address - Street 2:UNIT 104
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-8746
Practice Address - Country:US
Practice Address - Phone:443-745-0926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06759225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics