Provider Demographics
NPI:1003362948
Name:SMELTZ, TATHIANE
Entity Type:Individual
Prefix:
First Name:TATHIANE
Middle Name:
Last Name:SMELTZ
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 1:475 OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1534
Mailing Address - Country:US
Mailing Address - Phone:954-381-6156
Mailing Address - Fax:
Practice Address - Street 1:475 OVERLOOK RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1534
Practice Address - Country:US
Practice Address - Phone:954-381-6156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11472235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist