Samantha Jane Clark-Teague, O.T.A

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

3060-35-1455 Issued in IN

Practice address

5902 Hinsdale LN
Fort Wayne, IN 46835-1237

Phone

(260) 494-7854

NPI assigned

Mar 10, 2014

Last updated

Mar 10, 2014By 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)

Not enrolled

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

{
    "created_epoch": "1394409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394409600000",
    "number": "1396161766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5902 HINSDALE LANE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46835",
            "telephone_number": "260-494-7854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5902 HINSDALE LN",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468351237",
            "telephone_number": "260-494-7854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK-TEAGUE",
        "first_name": "SAMANTHA",
        "middle_name": "JANE",
        "name_prefix": "Ms.",
        "credential": "O.T.A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-10",
        "last_updated": "2014-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "IN",
            "license": "3060-35-1455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keith David Clancy, M.D.
• Megan Clancy
• Kama Clapper-Erpelding, FNP
• Clarity Carellc
• Clarity Counseling LLC
• Andrea Clark
• Brayden Claye Clark
• Candace Clark
• David W Clark, M.D.
• Erin D Clark, ATC

• Occupational Therapy Assistant in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Occupational Therapy Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2014; 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.