Basic Information
| Provider Information | |||||||||
| NPI: | 1487111696 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEMOTT | ||||||||
| FirstName: | SAMATHA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 RAVENCREST DR | ||||||||
| Address2: | |||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522453924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8135454423 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1330 QUAIL LAKE LOOP | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809064651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195402108 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2019 | ||||||||
| LastUpdateDate: | 02/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | OT.0005760 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.