Provider Demographics
NPI:1427773688
Name:SPENCER, SAMANTHA ASHLAN (OTR/L)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ASHLAN
Last Name:SPENCER
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 1:11417 SILVER QUEEN DR
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-1366
Mailing Address - Country:US
Mailing Address - Phone:903-826-1745
Mailing Address - Fax:
Practice Address - Street 1:1000 W CROSBY RD STE 136
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-6904
Practice Address - Country:US
Practice Address - Phone:972-237-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123083225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist