Healthcare Provider Details

I. General information

NPI: 1922553767
Provider Name (Legal Business Name): SAMANTHA DARCY OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA DAIL

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13835 N TATUM BLVD STE 9429
PHOENIX AZ
85032-0413
US

IV. Provider business mailing address

13835 N. TATUM BLVD STE 9429
PHOENIX AZ
85032-5590
US

V. Phone/Fax

Practice location:
  • Phone: 480-242-5903
  • Fax:
Mailing address:
  • Phone: 480-242-5903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTH-008164
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: