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NPI Code Detail

MEDICARE: DANA RENEE SAMMONS OTR/L

MEDICARE: DANA RENEE SAMMONS OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistIL

General Provider Information

NPI Number : 1285803031
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANA RENEE SAMMONS OTR/L
Provider Business Mailing Address
First Line : 311 DEERPATH CT
Second Line :
City : WAUCONDA
State : IL
Zip : 60084-3906
Country : US
Telephone Number : 847-487-9232
Fax Number :
Provider Business Practice Location Address
First Line : 5150 NORTHWEST HWY
Second Line : PINEHURST SQUARE MALL
City : CRYSTAL LAKE
State : IL
Zip : 60014-8058
Country : US
Telephone Number : 815-455-9800
Fax Number : 815-455-9359
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2008
Last Update Date : 02/26/2008

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Directions to “ DANA RENEE SAMMONS OTR/L” Practice Location

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