MEDICARE: KHANDICE 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	225000000X	Orthotic Fitter
2	1744P3200X	Prosthetics Case Management

General Provider Information

NPI Number	:	1922751122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHANDICE SMITH

Provider Business Mailing Address
First Line	:	PO BOX 320116
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33679-2116
Country	:	US
Telephone Number	:	470-471-9297
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 E JACKSON ST STE 3300
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-5228
Country	:	US
Telephone Number	:	470-471-9297
Fax Number	:

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

Provider Enumeration Date	:	01/28/2022
Last Update Date	:	01/28/2022

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Directions to “ KHANDICE SMITH ” Practice Location

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