Provider Demographics
NPI:1730486457
Name:SMITH, BRANDON LEE (CERTIFIED ORTHOTIST)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:M
Credentials:CERTIFIED ORTHOTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3244 KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503
Mailing Address - Country:US
Mailing Address - Phone:785-537-8897
Mailing Address - Fax:785-537-8893
Practice Address - Street 1:3244 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503
Practice Address - Country:US
Practice Address - Phone:785-537-8897
Practice Address - Fax:785-537-8893
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CS0162174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C50162OtherCERTIFICATION FROM BOC