MEDICARE: SAMANTHA LILLY MSOT,OTR/L,BHS,CPAM

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	OT26416	FL
2	224Z00000X	Occupational Therapy Assistant	OTA17588	FL

General Provider Information

NPI Number	:	1396520672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA LILLY MSOT,OTR/L,BHS,CPAM

Provider Business Mailing Address
First Line	:	135 W MINNESOTA AVE APT 1
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-3451
Country	:	US
Telephone Number	:	386-479-5086
Fax Number	:

Provider Business Practice Location Address
First Line	:	1952 N WILLIAMSON BLVD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-5261
Country	:	US
Telephone Number	:	386-363-2000
Fax Number	:

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

Provider Enumeration Date	:	08/25/2023
Last Update Date	:	12/08/2025

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