Provider Demographics
NPI:1538887484
Name:HOTTINGER, SAMANTHA JO (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:HOTTINGER
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:MRS
Other - First Name:SAMANTHA
Other - Middle Name:JO
Other - Last Name:CANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:445 E DUBLIN GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3192
Mailing Address - Country:US
Mailing Address - Phone:614-844-3800
Mailing Address - Fax:
Practice Address - Street 1:22 N 1ST ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5608
Practice Address - Country:US
Practice Address - Phone:740-334-4056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2615030Medicaid