Healthcare Provider Details

I. General information

NPI: 1760009336
Provider Name (Legal Business Name): SAMANTHA O'TOOLE MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 WESTGATE DR
BROCKTON MA
02301-1818
US

IV. Provider business mailing address

6225 SMITH AVE STE 100-1A
BALTIMORE MD
21209-3626
US

V. Phone/Fax

Practice location:
  • Phone: 866-727-8274
  • Fax:
Mailing address:
  • Phone: 866-727-8274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: