Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1194491670 |
---|---|
Provider Name | Maya A Smith |
First Address | Fort Hood, TX 76544-1752 |
Second Address | Fort Hood, TX 76544-1752 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2021 |
Last Update Date | 11/10/2021 |