Provider Demographics
NPI:1467592501
Name:SMITH, TIMOTHY B (HAS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:B
Last Name:SMITH
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 PAGE BACON RD
Mailing Address - Street 2:#1
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-1685
Mailing Address - Country:US
Mailing Address - Phone:850-819-1240
Mailing Address - Fax:
Practice Address - Street 1:217 PAGE BACON RD
Practice Address - Street 2:#1
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1685
Practice Address - Country:US
Practice Address - Phone:850-244-0422
Practice Address - Fax:850-244-5472
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS 3989237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist