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NPI Code Detail

MEDICARE: RYLIE EVAN SMITH

MEDICARE: RYLIE EVAN 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
1235Z00000XSpeech-Language Pathologist6155OK
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1700575487
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYLIE EVAN SMITH
Provider Business Mailing Address
First Line : 900 NE 122ND ST APT 2310
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73114-9226
Country : US
Telephone Number : 580-306-1294
Fax Number :
Provider Business Practice Location Address
First Line : 1400 E MEMORIAL RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73131-1240
Country : US
Telephone Number : 405-875-0040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2023
Last Update Date : 06/09/2024

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Directions to “ RYLIE EVAN SMITH ” Practice Location

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