MEDICARE: CARLY 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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1700196276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY SMITH

Provider Business Mailing Address
First Line	:	3106 SANTORINI CT
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-7709
Country	:	US
Telephone Number	:	952-393-2550
Fax Number	:

Provider Business Practice Location Address
First Line	:	7219 CESTRUM RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3218
Country	:	US
Telephone Number	:	952-393-2550
Fax Number	:

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

Provider Enumeration Date	:	10/18/2010
Last Update Date	:	01/08/2014

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Directions to “ CARLY SMITH ” Practice Location

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