MEDICARE: PAMELA E SMITH THERAPIES, INC.

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1639738537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAMELA E SMITH THERAPIES, INC.

Provider Business Mailing Address
First Line	:	3235 SE RIVER VISTA DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-5928
Country	:	US
Telephone Number	:	321-536-6761
Fax Number	:	772-408-0197

Provider Business Practice Location Address
First Line	:	3235 SE RIVER VISTA DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-5928
Country	:	US
Telephone Number	:	321-536-6761
Fax Number	:	772-408-0197

Authorized Official
Title or Position	:	OWNER
Name	:	PAMELA ELIZABETH SMITH
Credential	:	MA., CCC-SLP
Telephone Number	:	321-536-6761

Provider Enumeration Date	:	06/13/2019
Last Update Date	:	06/13/2019

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