Provider Demographics
NPI:1427478155
Name:SAMPSELL, HOLLY E (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:E
Last Name:SAMPSELL
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 1:1210 E BOGART RD
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-6411
Mailing Address - Country:US
Mailing Address - Phone:419-627-3900
Mailing Address - Fax:419-627-3999
Practice Address - Street 1:1210 E BOGART RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-6411
Practice Address - Country:US
Practice Address - Phone:419-627-3900
Practice Address - Fax:419-627-3999
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.04490224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant