Healthcare Provider Details

I. General information

NPI: 1215856737
Provider Name (Legal Business Name): SAMANTHA CONNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E LAKE AVE
NEW CARLISLE OH
45344-1417
US

IV. Provider business mailing address

1192 MASSACHUSETTS DR
XENIA OH
45385-4755
US

V. Phone/Fax

Practice location:
  • Phone: 937-679-5055
  • Fax:
Mailing address:
  • Phone: 937-543-2518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.026176
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: