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NPI Code Detail

MEDICARE: SAMANTHA LEWIS RBT

MEDICARE: SAMANTHA LEWIS RBT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-20-139675AR

General Provider Information

NPI Number : 1083212286
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA LEWIS RBT
Provider Business Mailing Address
First Line : 5704 EUPER LN STE 100
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-3256
Country : US
Telephone Number : 479-242-4480
Fax Number : 405-336-3008
Provider Business Practice Location Address
First Line : 5704 EUPER LN STE 100
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-3256
Country : US
Telephone Number : 479-242-4480
Fax Number : 405-336-3008
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2020
Last Update Date : 10/12/2020

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Directions to “ SAMANTHA LEWIS RBT” Practice Location

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