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NPI Code Detail

MEDICARE: MRS. SAMANTHA SMITH

MEDICARE: MRS. SAMANTHA 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1962270868
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SAMANTHA SMITH
Provider Business Mailing Address
First Line : 200 VESTAVIA PKWY
Second Line :
City : VESTAVIA
State : AL
Zip : 35216-7715
Country : US
Telephone Number : 205-490-5364
Fax Number : 312-929-0324
Provider Business Practice Location Address
First Line : 200 VESTAVIA PKWY
Second Line :
City : VESTAVIA
State : AL
Zip : 35216-7715
Country : US
Telephone Number : 205-490-5364
Fax Number : 312-929-0324
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2023
Last Update Date : 12/20/2023

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