Samantha Marie Proctor, OTDR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

107536 Issued in MN

Practice address

9645 Grove Cir N Ste 200
Maple Grove, MN 55369-2684

Phone

(763) 201-8191

NPI assigned

Aug 7, 2024

Last updated

Sep 18, 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

Enrolled in MN

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Interventional Spine and Pain Physicians PAGroup PAC ID 2466606264, 42 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Interventional Spine and Pain Physicians, PA

  • Specialist
  • Maple Grove, MN
  • NPI 1326398561

  Occupational Therapist

  Medicare reassignment Care Compare group NPD
• Physicians' Diagnostics & Rehabilitation,LTD

  • Physical Medicine & Rehabilitation Physician
  • Edina, MN
  • NPI 1073626081

  Occupational Therapist

  NPD (past)

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

{
    "created_epoch": "1722988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1508696048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11117 HILLSBORO AVE N",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "553163128",
            "telephone_number": "763-228-4274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9645 GROVE CIR N STE 200",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553692684",
            "telephone_number": "763-201-8191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROCTOR",
        "first_name": "SAMANTHA",
        "middle_name": "MARIE",
        "credential": "OTDR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-07",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "107536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Prestige Homecare LLC
• Andrea Price, PT
• Roberta Van Amber Prigge
• Chelsie Rae Prinsen, ATR
• Pro Medical Services, Inc.
• Rebecca Prosen
• Providence Home Care Services LLC
• Robin Jean Prugno, D.O.
• Jeffrey Allen Pumper, D.D.S.
• Mollana Carson Purdy, AUD

• Occupational Therapist in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Occupational Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.