Provider Demographics
NPI:1841906310
Name:SMITH, TALISHA J
Entity type:Individual
Prefix:
First Name:TALISHA
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20114 SORIA SPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-8202
Mailing Address - Country:US
Mailing Address - Phone:832-306-1804
Mailing Address - Fax:
Practice Address - Street 1:2706 ISABELLA ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-5446
Practice Address - Country:US
Practice Address - Phone:281-306-3388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT137206225700000X
TX808230163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery