Provider Demographics
NPI:1609103837
Name:SMELTZER, LAURA SUSAN (BEHAVIOR ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:SUSAN
Last Name:SMELTZER
Suffix:
Gender:F
Credentials:BEHAVIOR ASSISTANT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:SUSAN
Other - Last Name:MINOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BEHAVIOR ASSISTANT
Mailing Address - Street 1:9 W FILLMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-5054
Mailing Address - Country:US
Mailing Address - Phone:407-902-9533
Mailing Address - Fax:
Practice Address - Street 1:9 W FILLMORE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809
Practice Address - Country:US
Practice Address - Phone:407-902-9533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023279200Medicaid