Provider Demographics
NPI:1174028260
Name:MAPPES, SAMANTHA ASHLEY (OT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ASHLEY
Last Name:MAPPES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:ASHLEY
Other - Last Name:ASENCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:90 HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8138
Mailing Address - Country:US
Mailing Address - Phone:502-633-1007
Mailing Address - Fax:
Practice Address - Street 1:3918 TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37409-1352
Practice Address - Country:US
Practice Address - Phone:661-755-3820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006303A225X00000X
TN6772225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist