Provider Demographics
NPI:1134536527
Name:SMITH, MONICA OTERO (MAT, ATC, LAT)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:OTERO
Last Name:SMITH
Suffix:
Gender:F
Credentials:MAT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16302 LOOP 493
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-7805
Mailing Address - Country:US
Mailing Address - Phone:806-863-7105
Mailing Address - Fax:806-863-7181
Practice Address - Street 1:16302 LOOP 493
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-7805
Practice Address - Country:US
Practice Address - Phone:806-863-7105
Practice Address - Fax:806-863-7181
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT54102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer