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NPI Code Detail

MEDICARE: AMILEA R SMITH

MEDICARE: AMILEA R 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1679031363
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMILEA R SMITH
Provider Business Mailing Address
First Line : 1301 REDWOOD WAY STE 210
Second Line :
City : PETALUMA
State : CA
Zip : 94954-1134
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1301 REDWOOD WAY STE 210
Second Line :
City : PETALUMA
State : CA
Zip : 94954-1134
Country : US
Telephone Number : 507-778-5015
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2019
Last Update Date : 02/19/2026

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Directions to “ AMILEA R SMITH ” Practice Location

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