MEDICARE: BRITTANY SHENE SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1033741756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY SHENE SMITH

Provider Business Mailing Address
First Line	:	24 HEMLOCK ST
Second Line	:
City	:	PARK FOREST
State	:	IL
Zip	:	60466-2154
Country	:	US
Telephone Number	:	773-431-6140
Fax Number	:

Provider Business Practice Location Address
First Line	:	2818 S TRIPP AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-4336
Country	:	US
Telephone Number	:	773-240-5377
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2020
Last Update Date	:	02/11/2020

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Directions to “ BRITTANY SHENE SMITH ” Practice Location

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