MEDICARE: MRS. CARA VICTORIA 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	235Z00000X	Speech-Language Pathologist	03842	MD

General Provider Information

NPI Number	:	1811467400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARA VICTORIA SMITH

Provider Business Mailing Address
First Line	:	22313 HANOVER DR
Second Line	:
City	:	LEONARDTOWN
State	:	MD
Zip	:	20650-4137
Country	:	US
Telephone Number	:	301-475-2696
Fax Number	:

Provider Business Practice Location Address
First Line	:	PINEY POINT ELEMENTARY SCHOOL 44550 TALL TIMBERS ROAD
Second Line	:
City	:	TALL TIMBERS
State	:	MD
Zip	:	20690-2009
Country	:	US
Telephone Number	:	301-994-2205
Fax Number	:

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

Provider Enumeration Date	:	11/27/2018
Last Update Date	:	11/27/2018

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Directions to “ MRS. CARA VICTORIA SMITH ” Practice Location

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