MEDICARE: TIERANI 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	235Z00000X	Speech-Language Pathologist	5547	OK

General Provider Information

NPI Number	:	1871232314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIERANI SMITH

Provider Business Mailing Address
First Line	:	14001 MCAULEY BLVD STE 150
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-7006
Country	:	US
Telephone Number	:	405-464-9595
Fax Number	:	405-493-6787

Provider Business Practice Location Address
First Line	:	14001 MCAULEY BLVD STE 150
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-7006
Country	:	US
Telephone Number	:	405-464-9595
Fax Number	:	405-493-6787

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

Provider Enumeration Date	:	06/02/2022
Last Update Date	:	06/02/2022

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Directions to “ TIERANI SMITH ” Practice Location

Language	Start Address	Practice Location

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