Individual
SAMANTHA JOHANNE TATUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
610 E BRANNON ROAD SUITE 200, NICHOLASVILLE, KY 40356
Mailing address
5200 COMMERCE CROSSING 3RD FLOOR, LOUISVILLE, KY 40229
(502) 489-6615
(502) 489-5751
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
135045
KY
Other
Enumeration date
12/11/2019
Last updated
12/03/2020
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