Provider Demographics
NPI:1043102460
Name:BERTUCCI, SAMANTHA L (DO)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:L
Last Name:BERTUCCI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60040-1808
Mailing Address - Country:US
Mailing Address - Phone:224-324-1178
Mailing Address - Fax:
Practice Address - Street 1:2401 RAVINE WAY STE 100
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-7645
Practice Address - Country:US
Practice Address - Phone:847-724-4791
Practice Address - Fax:847-998-6916
Is Sole Proprietor?:No
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056016635225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist