MEDICARE: AKAYLA LARREN 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	106S00000X	Behavior Technician	BACB-793458	FL

General Provider Information

NPI Number	:	1356070270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AKAYLA LARREN SMITH

Provider Business Mailing Address
First Line	:	5955 RALEIGH ST APT 4404
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-2519
Country	:	US
Telephone Number	:	305-370-9555
Fax Number	:

Provider Business Practice Location Address
First Line	:	6889 W COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-6827
Country	:	US
Telephone Number	:	407-601-0491
Fax Number	:

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

Provider Enumeration Date	:	06/07/2022
Last Update Date	:	06/07/2022

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Directions to “ AKAYLA LARREN SMITH ” Practice Location

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