MEDICARE: TELAI SAMON RIVERS

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1285568386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TELAI SAMON RIVERS

Provider Business Mailing Address
First Line	:	8300 GREENSBORO DR STE L1-255
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-3605
Country	:	US
Telephone Number	:	571-777-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	11517 SUNSET HILLS RD
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20190-4704
Country	:	US
Telephone Number	:	571-777-9200
Fax Number	:

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

Provider Enumeration Date	:	06/11/2026
Last Update Date	:	06/11/2026

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Directions to “ TELAI SAMON RIVERS ” Practice Location

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