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General NPI Number Information
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NPI Number | 1396520672
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Entity Type | Individual
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Provider Name | SAMANTHA LILLY MSOT,OTR/L,BHS,CPAM
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Gender | Female
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Dates
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Enumeration Date | 08/25/2023
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 1952 N WILLIAMSON BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5261
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Country | US
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Telephone | 386-363-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 135 W MINNESOTA AVE APT 1
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City | DELAND
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State | FL
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Zip | 32720-3451
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Country | US
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Telephone | 386-479-5086
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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 | OT26416
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA17588
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License Number State | FL
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