Provider Demographics
NPI:1548912793
Name:OLCOTT, SAMANTHA MICHELLE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MICHELLE
Last Name:OLCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CHERYL LN
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-3742
Mailing Address - Country:US
Mailing Address - Phone:609-578-0746
Mailing Address - Fax:
Practice Address - Street 1:2085 INLAND DR STE A
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-1203
Practice Address - Country:US
Practice Address - Phone:541-267-5221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist