Healthcare Provider Details

I. General information

NPI: 1326811894
Provider Name (Legal Business Name): SAMANTHA BELLE WILKINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 ADAMS ST
OTTAWA IL
61350-4304
US

IV. Provider business mailing address

611 E VAN BUREN ST
OTTAWA IL
61350-3645
US

V. Phone/Fax

Practice location:
  • Phone: 815-434-0875
  • Fax: 815-434-2260
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: