MEDICARE: MEGAN 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	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1871247312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN SMITH

Provider Business Mailing Address
First Line	:	9934 BEAR LAKE RD
Second Line	:
City	:	FOREST CITY
State	:	FL
Zip	:	32703-1933
Country	:	US
Telephone Number	:	407-761-5154
Fax Number	:

Provider Business Practice Location Address
First Line	:	9934 BEAR LAKE RD
Second Line	:
City	:	FOREST CITY
State	:	FL
Zip	:	32703-1933
Country	:	US
Telephone Number	:	407-761-5154
Fax Number	:

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

Provider Enumeration Date	:	02/03/2022
Last Update Date	:	02/03/2022

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Directions to “ MEGAN SMITH ” Practice Location

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