Healthcare Provider Details

I. General information

NPI: 1396166468
Provider Name (Legal Business Name): SAMANTHA STILES MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2013
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13639 TORTONA LN APT 2109
WINDERMERE FL
34786-7467
US

IV. Provider business mailing address

13639 TORTONA LN APT 2109
WINDERMERE FL
34786-7467
US

V. Phone/Fax

Practice location:
  • Phone: 407-907-7936
  • Fax:
Mailing address:
  • Phone: 407-907-7936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT19186
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: