Samantha Lauren Wallenberg, MS, OTD, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

056.013694 Issued in IL

Practice address

310 Mosher Dr
Prophetstown, IL 61277-1001

Phone

(309) 525-0231

NPI assigned

Jul 1, 2024

Last updated

Jul 1, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1719792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1306682208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2536 W CORTEZ ST APT BF",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606223456",
            "telephone_number": "224-595-8744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 MOSHER DR",
            "city": "PROPHETSTOWN",
            "state": "IL",
            "postal_code": "612771001",
            "telephone_number": "309-525-0231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLENBERG",
        "first_name": "SAMANTHA",
        "middle_name": "LAUREN",
        "credential": "MS, OTD, OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-01",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056.013694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Prophetstown, IL
• Providers in Prophetstown, IL by specialty
• Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.