Samantha Cooper Wallace

NPI #1790457158 in Bedford, Massachusetts

Provider Information

NPI Number: 1790457158
Entity Type: Individual
Name: Samantha Cooper Wallace
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Oct 4, 2021
Last Updated: Oct 4, 2021

Practice Location

Address: 205 BURLINGTON RD
City: Bedford
State: Massachusetts
ZIP Code: 01730-1406
Phone: (781) 761-5089

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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