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General NPI Number Information
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NPI Number | 1174531180
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Entity Type | Individual
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Provider Name | SAMANTHA RATLIFF WAMPLER MS CCC SLP
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Gender | Female
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 103 NORTH ST SUITE B BRISTOL REGIONAL SPEECH & HEARING CENTER
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City | BRISTOL
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State | VA
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Zip | 24201-3201
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Country | US
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Telephone | 276-669-6331
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Fax | 276-669-2950
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Provider Business Mailing Address
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Address Line | 500 CLUB POINTE DR
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City | BLOUNTVILLE
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State | TN
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Zip | 37617-5572
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Country | US
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Telephone | 423-323-5557
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2202004328
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License Number State | VA
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