MEDICARE: MAYA A 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	224P00000X	Prosthetist

General Provider Information

NPI Number	:	1194491670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYA A SMITH

Provider Business Mailing Address
First Line	:	48240 MIFFLIN ST
Second Line	:
City	:	FORT HOOD
State	:	TX
Zip	:	76544-1752
Country	:	US
Telephone Number	:	662-209-0809
Fax Number	:

Provider Business Practice Location Address
First Line	:	48240 MIFFLIN ST
Second Line	:
City	:	FORT HOOD
State	:	TX
Zip	:	76544-1752
Country	:	US
Telephone Number	:	662-209-0809
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	10/11/2021

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Directions to “ MAYA A SMITH ” Practice Location

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