Healthcare Provider Details

I. General information

NPI: 1295240588
Provider Name (Legal Business Name): ERIC TODD SMITH OTC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 16TH AVE SE
DECATUR AL
35601-3595
US

IV. Provider business mailing address

1103 16TH AVE SE
DECATUR AL
35601-3595
US

V. Phone/Fax

Practice location:
  • Phone: 256-355-0362
  • Fax:
Mailing address:
  • Phone: 256-350-0362
  • Fax: 256-355-9779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number012125060
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number25-0208
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code246ZX2200X
TaxonomyOrthopedic Assistant
License Number25-0208
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: