Individual
SAMANTHA MARIE PROCTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTDR/L
Contact information
Practice address
9645 GROVE CIR N STE 200, MAPLE GROVE, MN 55369-2684
(763) 201-8191
Mailing address
11117 HILLSBORO AVE N, CHAMPLIN, MN 55316-3128
(763) 228-4274
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
107536
MN
Other
Enumeration date
08/07/2024
Last updated
09/18/2024
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