Basic Information
| Provider Information | |||||||||
| NPI: | 1780063818 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEVOE | ||||||||
| FirstName: | SAMANTHA | ||||||||
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| OtherLastName: | STEVENSON | ||||||||
| OtherFirstName: | SAMANTHA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 20 MAIN STREET | ||||||||
| Address2: | ENTRANCE G | ||||||||
| City: | ACTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782631427 | ||||||||
| FaxNumber: | 9782631696 | ||||||||
| Practice Location | |||||||||
| Address1: | 1406 HAYS ST | ||||||||
| Address2: | SUITE 8 | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323012833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505210242 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2015 | ||||||||
| LastUpdateDate: | 08/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.