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General NPI Number Information
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NPI Number | 1710401963
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Entity Type | Individual
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Provider Name | SAMANTHA L CHAMBERLAIN PT, DPT, CERT-MMOA
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Gender | Female
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Dates
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Enumeration Date | 07/31/2017
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Last Update Date | 03/25/2023
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Provider Practice Location Address
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Address Line | 21 E 3RD ST
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City | GROVE
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State | OK
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Zip | 74344-7034
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Country | US
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Telephone | 918-791-8789
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Fax | 877-912-0432
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Provider Business Mailing Address
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Address Line | 2096 LOCUST ST
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City | JAY
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State | OK
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Zip | 74346-3876
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Country | US
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Telephone | 918-281-9521
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Fax | 877-912-0432
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5349
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License Number State | OK
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