MEDICARE: MRS. SARAH KOMORNIK SMITH MSP CCC SLP

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	235Z00000X	Speech-Language Pathologist	3902	SC

General Provider Information

NPI Number	:	1083697767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH KOMORNIK SMITH MSP CCC SLP

Provider Business Mailing Address
First Line	:	2222 SUNSET CIR
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-7712
Country	:	US
Telephone Number	:	803-622-7939
Fax Number	:	803-548-6200

Provider Business Practice Location Address
First Line	:	2222 SUNSET CIR
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-7712
Country	:	US
Telephone Number	:	803-622-7939
Fax Number	:	803-548-6200

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

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	07/08/2007

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