Samantha Lauren Wallenberg, MS, OTD, OTR/L is a medicare enrolled "Occupational Therapist" provider in Prophetstown, Illinois. Her current practice location is
310 Mosher Dr, Prophetstown, Illinois. You can reach out to her office (for appointments etc.) via phone at
(309) 525-0231.
Samantha Lauren Wallenberg is licensed to practice in Illinois (license number 056.013694) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1306682208.
Healthcare Provider's Profile
| Full Name | Samantha Lauren Wallenberg |
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| Gender | Female |
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| Speciality | Occupational Therapist |
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| Location | 310 Mosher Dr, Prophetstown, Illinois |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1306682208
- Provider Enumeration Date: 07/01/2024
- Last Update Date: 07/01/2024
Medicare PECOS Information:
- PECOS PAC ID: 5294271870
- Enrollment ID: I20240718003895
Medical Identifiers
Medical identifiers for Samantha Lauren Wallenberg such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1306682208 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 225X00000X | Occupational Therapist | 056.013694 (Illinois) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Samantha Lauren Wallenberg allows following entities to bill medicare on her behalf.
| Provider Name | At Home By Enhance Therapies Llc |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1124603246
PECOS PAC ID: 4183033210
Enrollment ID: O20220511002297 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Samantha Lauren Wallenberg is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Samantha Lauren Wallenberg, MS, OTD, OTR/L
2536 W Cortez St Apt Bf,
Chicago, IL 60622-3456
Ph: (224) 595-8744 | Samantha Lauren Wallenberg, MS, OTD, OTR/L
310 Mosher Dr,
Prophetstown, IL 61277-1001
Ph: (309) 525-0231 |
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