Healthcare Provider Details

I. General information

NPI: 1982211272
Provider Name (Legal Business Name): SAMANTHA LAUREN BRANNIES MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 WINTER GARDEN VINELAND RD STE 10
WINTER GARDEN FL
34787-4380
US

IV. Provider business mailing address

1201 WINTER GARDEN VINELAND RD STE 10
WINTER GARDEN FL
34787-4380
US

V. Phone/Fax

Practice location:
  • Phone: 407-654-5455
  • Fax:
Mailing address:
  • Phone: 407-654-5455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT26905
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: