Provider Demographics
NPI:1205162260
Name:SMITH, CYNTHIA M (COTA)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S AUSTIN AVE
Mailing Address - Street 2:#1310
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-5637
Mailing Address - Country:US
Mailing Address - Phone:512-864-6054
Mailing Address - Fax:512-869-8157
Practice Address - Street 1:501 S AUSTIN AVE
Practice Address - Street 2:#1310
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-5637
Practice Address - Country:US
Practice Address - Phone:512-864-6054
Practice Address - Fax:512-869-8157
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207492174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207492OtherCOTA