MEDICARE: SAMANTHA SAGE MOE HARRINGTON

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	:	1750954335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA SAGE MOE HARRINGTON

Provider Business Mailing Address
First Line	:	5300 E CHERRY CREEK SOUTH DR APT 618
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80246-2737
Country	:	US
Telephone Number	:	303-995-7444
Fax Number	:

Provider Business Practice Location Address
First Line	:	1385 S COLORADO BLVD STE 610
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-3324
Country	:	US
Telephone Number	:	720-696-9611
Fax Number	:

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

Provider Enumeration Date	:	07/21/2021
Last Update Date	:	07/21/2021

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