Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 225400000X | Rehabilitation Practitioner |
NPI | 1023320736 |
---|---|
Provider Name | Ms. Amesha Corine Smith |
First Address | Hesperia, CA 92345-7922 |
Second Address | Hesperia, CA 92345-7922 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2010 |
Last Update Date | 20/07/2015 |