Provider Demographics
NPI:1548620347
Name:MAREK, SAMANTHA (LAC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:MAREK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 AMESBURY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2370
Mailing Address - Country:US
Mailing Address - Phone:614-598-5760
Mailing Address - Fax:
Practice Address - Street 1:830 E JOHNSTOWN RD
Practice Address - Street 2:SUITE C
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3815
Practice Address - Country:US
Practice Address - Phone:614-584-7989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000316171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist