MEDICARE: SAMANTHA EAGLES

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
1	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1093496150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA EAGLES

Provider Business Mailing Address
First Line	:	7108 S KANNER HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-7462
Country	:	US
Telephone Number	:	855-832-6772
Fax Number	:

Provider Business Practice Location Address
First Line	:	2442 GERALD AVE
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-4728
Country	:	US
Telephone Number	:	248-413-7975
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	07/31/2023

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Directions to “ SAMANTHA EAGLES ” Practice Location

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