MEDICARE: CINDY L. 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	335E00000X	Prosthetic/Orthotic Supplier	LO 20,LPED 27, LPO47	OK

General Provider Information

NPI Number	:	1134122534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CINDY L. SMITH

Provider Business Mailing Address
First Line	:	8121 S WESTERN AVE
Second Line	:	STE I
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-2546
Country	:	US
Telephone Number	:	405-366-0184
Fax Number	:	405-604-6818

Provider Business Practice Location Address
First Line	:	8121 S WESTERN AVE
Second Line	:	STE I
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-2546
Country	:	US
Telephone Number	:	405-366-0184
Fax Number	:	405-604-6818

Authorized Official
Title or Position	:	OWNER
Name	:	MS. CINDY L SMITH
Credential	:	L.O., L.PED
Telephone Number	:	405-366-0184

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	01/11/2011

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