MEDICARE: MS. SAMANTHA ANDREA ODOM SLPA

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	2355S0801X	Speech-Language Assistant	33351	TX

General Provider Information

NPI Number	:	1891296844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SAMANTHA ANDREA ODOM SLPA

Provider Business Mailing Address
First Line	:	9722 GLENWOOD FOREST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77078-2823
Country	:	US
Telephone Number	:	713-377-8620
Fax Number	:

Provider Business Practice Location Address
First Line	:	9722 GLENWOOD FOREST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77078-2823
Country	:	US
Telephone Number	:	713-377-8620
Fax Number	:

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

Provider Enumeration Date	:	02/26/2018
Last Update Date	:	02/26/2018

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