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General NPI Number Information
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NPI Number | 1003617861
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Entity Type | Individual
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Provider Name | INDIA JENEIH SMITH
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Gender | Female
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 445 W OAK ST
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City | KISSIMMEE
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State | FL
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Zip | 34741-6627
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Country | US
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Telephone | 407-219-0402
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Fax |
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Provider Business Mailing Address
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Address Line | 2314 PRIME CIR APT B
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City | KISSIMMEE
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State | FL
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Zip | 34746-5608
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Country | US
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Telephone | 828-435-5473
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-25-420697
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License Number State | FL
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