Healthcare Provider Details

I. General information

NPI: 1538761481
Provider Name (Legal Business Name): SAMANTHA ADAM OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2020
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 TOWN CENTER BLVD STE I
ODENTON MD
21113-1232
US

IV. Provider business mailing address

1110 TOWN CENTER BLVD STE I
ODENTON MD
21113-1232
US

V. Phone/Fax

Practice location:
  • Phone: 410-672-8091
  • Fax:
Mailing address:
  • Phone: 410-672-8091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number09472
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: