Provider Demographics
NPI:1831806819
Name:MORRISSEY, SAMANTHA TAYLOR (MSOT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:TAYLOR
Last Name:MORRISSEY
Suffix:
Gender:
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 NE GATEWAY CT NE STE 204-A
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2414
Mailing Address - Country:US
Mailing Address - Phone:704-403-9239
Mailing Address - Fax:
Practice Address - Street 1:1090 NE GATEWAY CT NE STE 204-A
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2414
Practice Address - Country:US
Practice Address - Phone:704-403-9239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15402225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty