MEDICARE: VALASCO 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	225XP0019X	Physical Rehabilitation Occupational Therapist		GA

General Provider Information

NPI Number	:	1205203320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALASCO SMITH

Provider Business Mailing Address
First Line	:	1266 W PACES FERRY RD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-2306
Country	:	US
Telephone Number	:	678-521-7345
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 BISHOP ST NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-4366
Country	:	US
Telephone Number	:	678-521-7345
Fax Number	:

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

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	08/24/2015

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Directions to “ VALASCO SMITH ” Practice Location

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