MEDICARE: SAMANTHA BARTLEY OT

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
1	225X00000X	Occupational Therapist	31005848A	IN
2	225XP0200X	Pediatric Occupational Therapist	31005848A	IN

General Provider Information

NPI Number	:	1306239561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA BARTLEY OT

Provider Business Mailing Address
First Line	:	134 E COLLINS RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-5302
Country	:	US
Telephone Number	:	260-241-6879
Fax Number	:

Provider Business Practice Location Address
First Line	:	134 E COLLINS RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-5302
Country	:	US
Telephone Number	:	260-241-6879
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2015
Last Update Date	:	08/22/2019

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