Healthcare Provider Details

I. General information

NPI: 1881285682
Provider Name (Legal Business Name): SAMANTHA DUGGAN OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13385 W MCDOWELL RD
GOODYEAR AZ
85395-2631
US

IV. Provider business mailing address

19658 CAMBRIDGE DR
MOKENA IL
60448-7931
US

V. Phone/Fax

Practice location:
  • Phone: 623-986-5110
  • Fax:
Mailing address:
  • Phone: 708-539-6118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-008447
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: