Healthcare Provider Details

I. General information

NPI: 1578043634
Provider Name (Legal Business Name): SAMANTHA JEANE NORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 N EAST ST
PICKERINGTON OH
43147-1585
US

IV. Provider business mailing address

9668 WAGONWOOD DR
PICKERINGTON OH
43147-8669
US

V. Phone/Fax

Practice location:
  • Phone: 614-833-2110
  • Fax:
Mailing address:
  • Phone: 414-491-1208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT009691
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: