MEDICARE: CHELSEA 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	106S00000X	Behavior Technician	RBT-21-179822	OK

General Provider Information

NPI Number	:	1942699657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA SMITH

Provider Business Mailing Address
First Line	:	308 N ASPEN AVE
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-2205
Country	:	US
Telephone Number	:	539-777-0940
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 N ASPEN AVE
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-2205
Country	:	US
Telephone Number	:	539-777-0940
Fax Number	:

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

Provider Enumeration Date	:	01/19/2015
Last Update Date	:	09/24/2021

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Directions to “ CHELSEA SMITH ” Practice Location

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