Healthcare Provider Details

I. General information

NPI: 1417411323
Provider Name (Legal Business Name): SAMANTHA JEANINE LIPFORD OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA CONLEY

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 MEDICAL CENTER DR
WILMINGTON NC
28401-7305
US

IV. Provider business mailing address

3500 DEPAUW BLVD STE 3070
INDIANAPOLIS IN
46268-6135
US

V. Phone/Fax

Practice location:
  • Phone: 910-756-3447
  • Fax: 317-520-8200
Mailing address:
  • Phone: 855-324-0885
  • Fax: 317-520-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15003
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: