MEDICARE: SAMANTHA LOUISE LYMAN OTD, 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
1	225X00000X	Occupational Therapist	OT61320007	WA

General Provider Information

NPI Number	:	1679204416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA LOUISE LYMAN OTD, OTR/L

Provider Business Mailing Address
First Line	:	1700 EDMONDS AVE NE STE B
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98056-2713
Country	:	US
Telephone Number	:	425-747-4004
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 EDMONDS AVE NE STE B
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98056-2713
Country	:	US
Telephone Number	:	425-747-4004
Fax Number	:

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

Provider Enumeration Date	:	06/22/2022
Last Update Date	:	12/03/2025

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