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Individual

MS. SAMANTHA JANE CLARK-TEAGUE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
O.T.A

Contact information

Practice address
5902 HINSDALE LN, FORT WAYNE, IN 46835-1237
(260) 494-7854
Mailing address
5902 HINSDALE LANE, FORT WAYNE, IN 46835
(260) 494-7854

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3060-35-1455
IN

Other

Enumeration date
03/10/2014
Last updated
03/10/2014
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