Provider Demographics
NPI:1487219846
Name:CLINE, SAMANTHA (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:CLINE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:REESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:103 S CHAMBERY DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-3868
Mailing Address - Country:US
Mailing Address - Phone:913-963-5509
Mailing Address - Fax:
Practice Address - Street 1:6406 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1507
Practice Address - Country:US
Practice Address - Phone:913-627-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1801570224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant