MEDICARE: MS. TIERENY R SMITH RECREATIONTHERAPIST

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	225800000X	Recreation Therapist	1545	TX

General Provider Information

NPI Number	:	1376371625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TIERENY R SMITH RECREATIONTHERAPIST

Provider Business Mailing Address
First Line	:	3615 ROLLING SPRINGS LN
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-8158
Country	:	US
Telephone Number	:	346-616-8228
Fax Number	:

Provider Business Practice Location Address
First Line	:	3615 ROLLING SPRINGS LN
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-8158
Country	:	US
Telephone Number	:	346-616-8228
Fax Number	:

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

Provider Enumeration Date	:	07/25/2024
Last Update Date	:	11/29/2024

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