Provider Demographics
NPI:1871107904
Name:MCNEELY, SAMANTHA KAISHA (MSOT)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:KAISHA
Last Name:MCNEELY
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:1060 HARRISON RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-3586
Mailing Address - Country:US
Mailing Address - Phone:719-579-2000
Mailing Address - Fax:
Practice Address - Street 1:714 W ORMAN AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-1428
Practice Address - Country:US
Practice Address - Phone:719-289-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-05
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COT-OT0000031225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist