Provider Demographics
NPI:1376236851
Name:SMITH, LA TEASHA RA KAYLE
Entity Type:Individual
Prefix:MS
First Name:LA TEASHA
Middle Name:RA KAYLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4607 SNOWDROP CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-5446
Mailing Address - Country:US
Mailing Address - Phone:832-363-2566
Mailing Address - Fax:
Practice Address - Street 1:4607 SNOWDROP CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-5446
Practice Address - Country:US
Practice Address - Phone:832-363-2566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX335E00000X, 347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No335E00000XSuppliersProsthetic/Orthotic Supplier