MEDICARE: SAMANTHA NICOLE COYLE

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1265177620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA NICOLE COYLE

Provider Business Mailing Address
First Line	:	14 FLETCHER ST UNIT 1
Second Line	:
City	:	CHELMSFORD
State	:	MA
Zip	:	01824-2713
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 FLETCHER ST UNIT 1
Second Line	:
City	:	CHELMSFORD
State	:	MA
Zip	:	01824-2713
Country	:	US
Telephone Number	:	978-212-9626
Fax Number	:

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

Provider Enumeration Date	:	04/30/2022
Last Update Date	:	04/30/2022

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Directions to “ SAMANTHA NICOLE COYLE ” Practice Location

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