Healthcare Provider Details

I. General information

NPI: 1699682435
Provider Name (Legal Business Name): SAMANTHA COUCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 W CENTENNIAL AVE
CARTHAGE MO
64836-2816
US

IV. Provider business mailing address

205 W TYNDAL ST
AURORA MO
65605-1256
US

V. Phone/Fax

Practice location:
  • Phone: 417-359-7000
  • Fax:
Mailing address:
  • Phone: 417-229-5814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2026040547
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: