Most Relevant Information
Provider Data
| NPI Number: | 1003454190 |
| Provider Name: | SAMANTHA BROOKE LEE |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: | RBT-19-90479 |
Most Important Dates
| Enumeration Date: | 12/19/2019 |
| Last Updated: | 12/19/2019 |
Provider Practice Location
1501 W TAPP RD
BLOOMINGTON
IN
474033459
Practice Location Phone/Fax
| Phone: | 8123304460 |
| Fax: | 8123304461 |
Provider Mailing Location
1501 W TAPP RD
BLOOMINGTON
IN
474033459
Provider Mailing Phone/Fax
| Phone: | 8123304460 |
| Fax: | 8123304461 |