Individual
TIMOTHY SAMET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1111 UNIVERSITY DR, EDWARDSVILLE, IL 62025-5589
(618) 692-2273
Mailing address
4 CHURCHILL CT, EDWARDSVILLE, IL 62025-3156
(414) 758-0437
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057003485
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057003485
ILLINOIS DEPARTMENT OF PROFESSIONAL REGULATION LICENSE NUMBER
IL
Enumeration date
05/17/2021
Last updated
05/17/2021
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