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General NPI Number Information
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NPI Number | 1003678053
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Entity Type | Individual
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Provider Name | SAMANTHA PALUCHNIAK MOT, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/25/2024
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 1930 WISCONSIN AVE STE 31
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City | GRAFTON
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State | WI
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Zip | 53024-2632
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Country | US
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Telephone | 262-846-5141
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Fax |
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Provider Business Mailing Address
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Address Line | 211 W JUNIPER DR
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City | GRAFTON
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State | WI
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Zip | 53024-2235
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Country | US
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Telephone | 608-751-2354
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5443-26
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License Number State | WI
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