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NPI Code Detail

MEDICARE: SAMANTHA N RILEY

MEDICARE: SAMANTHA N RILEY
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
1106S00000XBehavior Technician
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1821691916
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA N RILEY
Provider Business Mailing Address
First Line : 83 WESTON AVE
Second Line :
City : HOLBROOK
State : MA
Zip : 02343-1428
Country : US
Telephone Number : 781-228-1520
Fax Number :
Provider Business Practice Location Address
First Line : 800 TECHNOLOGY CENTER DR STE 110
Second Line :
City : STOUGHTON
State : MA
Zip : 02072-4721
Country : US
Telephone Number : 781-290-3886
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2020
Last Update Date : 08/25/2024

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Directions to “ SAMANTHA N RILEY ” Practice Location

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