Individual
MRS. SAMANTHA JANE MCCOLLOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
712 W 2ND ST, LEAVENWORTH, IN 47137-2264
(812) 739-2292
Mailing address
712 W 2ND ST, LEAVENWORTH, IN 47137-2264
(812) 739-2292
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32002736A
IN
Other
Enumeration date
10/21/2014
Last updated
10/21/2014
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