MEDICARE: SAMANTHA JOY HANSHAW OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	13788	NC
2	225X00000X	Occupational Therapist	OT.6067	SC

General Provider Information

NPI Number	:	1639767171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA JOY HANSHAW OTR/L

Provider Business Mailing Address
First Line	:	397 ESTHWAITE DR SE
Second Line	:
City	:	LELAND
State	:	NC
Zip	:	28451-1859
Country	:	US
Telephone Number	:	717-917-7924
Fax Number	:

Provider Business Practice Location Address
First Line	:	1174 TURLINGTON AVE STE 203
Second Line	:
City	:	LELAND
State	:	NC
Zip	:	28451-1099
Country	:	US
Telephone Number	:	910-508-4681
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2021
Last Update Date	:	03/25/2026

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