MEDICARE: SPENCER J SMITH CPO, LOP

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	222Z00000X	Orthotist	1480	TX
2	224P00000X	Prosthetist	1480	TX

General Provider Information

NPI Number	:	1891058004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPENCER J SMITH CPO, LOP

Provider Business Mailing Address
First Line	:	230 SPRING HILL DR
Second Line	:	SUITE 335
City	:	SPRING
State	:	TX
Zip	:	77386-2388
Country	:	US
Telephone Number	:	281-296-8999
Fax Number	:	281-296-8989

Provider Business Practice Location Address
First Line	:	230 SPRING HILL DR
Second Line	:	SUITE 335
City	:	SPRING
State	:	TX
Zip	:	77386-2388
Country	:	US
Telephone Number	:	281-296-8999
Fax Number	:	281-296-8989

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

Provider Enumeration Date	:	06/21/2012
Last Update Date	:	06/25/2012

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