Provider Demographics
NPI:1730755869
Name:ADAMS, SAMANTHA RAE (OT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RAE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:RAE
Other - Last Name:WORKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13952 S ROCKWELL VIEW LN
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9868
Mailing Address - Country:US
Mailing Address - Phone:801-231-9455
Mailing Address - Fax:
Practice Address - Street 1:10322 N 4800 W
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-8965
Practice Address - Country:US
Practice Address - Phone:800-967-4667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-30
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10842210-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist