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General NPI Number Information
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NPI Number | 1972420552
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Entity Type | Individual
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Provider Name | SAMANTHA FORTAIN
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Gender | Female
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Dates
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Enumeration Date | 07/02/2026
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Last Update Date | 07/02/2026
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Provider Practice Location Address
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Address Line | 145 PILOT SCHOOL RD
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City | THOMASVILLE
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State | NC
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Zip | 27360-0058
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Country | US
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Telephone | 336-472-7965
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Fax |
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Provider Business Mailing Address
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Address Line | 184 HIGH ST STE 701
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City | BOSTON
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State | MA
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Zip | 02110-3025
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Country | US
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Telephone | 800-337-5965
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 30004528
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License Number State | NC
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