Provider Demographics
NPI:1710296728
Name:BAUMANN, SAMANTHA (OTRL)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:BAUMANN
Suffix:
Gender:
Credentials:OTRL
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:OSTERHOUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36626 TESSENS DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-1949
Mailing Address - Country:US
Mailing Address - Phone:586-382-3634
Mailing Address - Fax:
Practice Address - Street 1:1475 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2653
Practice Address - Country:US
Practice Address - Phone:313-278-4601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-26
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MI225800000X
MI526010225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist