Healthcare Provider Details

I. General information

NPI: 1427586098
Provider Name (Legal Business Name): TODD C SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 WALNUT DR
ARDMORE OK
73401-2354
US

IV. Provider business mailing address

1109 WALNUT DR
ARDMORE OK
73401-2354
US

V. Phone/Fax

Practice location:
  • Phone: 580-226-7900
  • Fax:
Mailing address:
  • Phone: 580-226-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: