MEDICARE: LONNETTA 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	103K00000X	Behavior Analyst		OK

General Provider Information

NPI Number	:	1851721799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LONNETTA SMITH

Provider Business Mailing Address
First Line	:	7901 NE 10TH ST STE A209
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-3689
Country	:	US
Telephone Number	:	405-455-4646
Fax Number	:

Provider Business Practice Location Address
First Line	:	7901 NE 10TH ST STE A209
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-3689
Country	:	US
Telephone Number	:	405-455-4646
Fax Number	:

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

Provider Enumeration Date	:	11/13/2013
Last Update Date	:	11/13/2013

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Directions to “ LONNETTA SMITH ” Practice Location

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