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NPI Code Detail

MEDICARE: MARY KATHLEEN SMITH

MEDICARE: MARY KATHLEEN 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
1235Z00000XSpeech-Language PathologistSA6063

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144339409
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY KATHLEEN SMITH
Provider Business Mailing Address
First Line : 350 BRADEN AVE
Second Line :
City : SARASOTA
State : FL
Zip : 34243-2001
Country : US
Telephone Number : 941-355-7637
Fax Number : 941-444-2271
Provider Business Practice Location Address
First Line : 350 BRADEN AVE
Second Line :
City : SARASOTA
State : FL
Zip : 34243-2001
Country : US
Telephone Number : 941-355-7637
Fax Number : 941-444-2271
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 08/13/2021

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Directions to “ MARY KATHLEEN SMITH ” Practice Location

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