Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Samantha Marie Proctor, OTDR/L

Individual provider Occupational Therapist · NPI 1508696048

Samantha Marie Proctor, OTDR/L is an Occupational Therapist in Private Practice in Maple Grove, Minnesota. Qualified in 2024, 2 years ago. Practices with Interventional Spine and Pain Physicians PA, a 43-clinician group and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
2
Licensed in
MN
In the registry since
2024
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Practice location Address checks out

9645 Grove Cir N Ste 200
Maple Grove, MN 55369-2684
Phone: (763) 201-8191
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Occupational Therapist (primary) Taxonomy 225X00000X · Licence 107536 (MN)

Record details

NPI number1508696048
Entity typeIndividual (Type 1)
GenderFemale
Credentials OTDR/L
Sole proprietorNo
NPI enumeratedAugust 7, 2024
Last updated in NPPESSeptember 18, 2024
Certification dateSeptember 18, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOCCUPATIONAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Interventional Spine And Pain Physicians Pa — 43 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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