MEDICARE: MRS. SAMANTHA MARIE TRESHAM

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	104100000X	Social Worker		AK

General Provider Information

NPI Number	:	1336659994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SAMANTHA MARIE TRESHAM

Provider Business Mailing Address
First Line	:	10355 E PALMER WASILLA HWY STE 110
Second Line	:
City	:	PALMER
State	:	AK
Zip	:	99645-8876
Country	:	US
Telephone Number	:	907-746-3445
Fax Number	:	907-746-3439

Provider Business Practice Location Address
First Line	:	10355 E PALMER WASILLA HWY STE 110
Second Line	:
City	:	PALMER
State	:	AK
Zip	:	99645-8876
Country	:	US
Telephone Number	:	907-746-3445
Fax Number	:	907-746-3439

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

Provider Enumeration Date	:	10/09/2017
Last Update Date	:	10/09/2017

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