Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | C.F.O.00226 | FL |
NPI | 1386906360 |
---|---|
Provider Name | Kyle Smith |
First Address | Pensacola, FL 32504-8277 |
Second Address | Pensacola, FL 32504-8277 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2012 |
Last Update Date | 14/06/2012 |