Provider Demographics
NPI:1306410618
Name:COUTURE, SAMANTHA (RD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:COUTURE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CHESTNUT ST APT 207
Mailing Address - Street 2:
Mailing Address - City:FOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:02035-1456
Mailing Address - Country:US
Mailing Address - Phone:860-338-4896
Mailing Address - Fax:
Practice Address - Street 1:1 PATRIOT PL
Practice Address - Street 2:
Practice Address - City:FOXBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:02035-1374
Practice Address - Country:US
Practice Address - Phone:508-543-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered