Most Relevant Information
Provider Data
| NPI Number: | 1003441189 |
| Provider Name: | SAMANTHA KAY RASTALL |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/09/2020 |
| Last Updated: | 03/10/2020 |
Provider Practice Location
1490 E BELTLINE AVE SE
GRAND RAPIDS
MI
495064336
Practice Location Phone/Fax
| Phone: | 6162485205 |
| Fax: |
Provider Mailing Location
1490 E BELTLINE AVE SE
GRAND RAPIDS
MI
495064336
Provider Mailing Phone/Fax
| Phone: | 6162485205 |
| Fax: |