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Individual

MR. SAMUEL JOSEPH PORTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
COTA/L

Contact information

Practice address
1265 UNION AVE FL 10, MEMPHIS, TN 38104-3415
(901) 546-2400
Mailing address
5671 CHAPMAN AVE, MEMPHIS, TN 38119-7107
(901) 378-2932

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3001
TN

Other

Enumeration date
04/07/2023
Last updated
04/07/2023
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