Healthcare Provider Details

I. General information

NPI: 1093500365
Provider Name (Legal Business Name): SAMANTHA AUSTIN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6777 W MAPLE RD
WEST BLOOMFIELD MI
48322-3013
US

IV. Provider business mailing address

6777 W MAPLE RD
WEST BLOOMFIELD MI
48322-3013
US

V. Phone/Fax

Practice location:
  • Phone: 248-325-1000
  • Fax:
Mailing address:
  • Phone: 248-325-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201014102
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: