MEDICARE: AMY TARTER 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	225500000X	Respiratory/Developmental/Rehabilitative Specialist/Technologist

General Provider Information

NPI Number	:	1750574943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY TARTER SMITH

Provider Business Mailing Address
First Line	:	82 HIGH POINT DR
Second Line	:
City	:	SOMERSET
State	:	KY
Zip	:	42501-3005
Country	:	US
Telephone Number	:	606-678-2034
Fax Number	:	606-678-2004

Provider Business Practice Location Address
First Line	:	82 HIGH POINT DR
Second Line	:
City	:	SOMERSET
State	:	KY
Zip	:	42501-3005
Country	:	US
Telephone Number	:	606-678-2034
Fax Number	:	606-678-2004

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

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	08/22/2007

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