Provider Demographics
NPI:1053637397
Name:SMYTH, NANCY MARIE (MOT/OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:MARIE
Last Name:SMYTH
Suffix:
Gender:F
Credentials:MOT/OTR/L
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:MARIE
Other - Last Name:FREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:WAITSFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05673-0760
Mailing Address - Country:US
Mailing Address - Phone:802-279-2091
Mailing Address - Fax:802-496-9874
Practice Address - Street 1:105-4 MADRIVER GREEN
Practice Address - Street 2:
Practice Address - City:WAITSFIELD
Practice Address - State:VT
Practice Address - Zip Code:05673-0760
Practice Address - Country:US
Practice Address - Phone:802-279-2091
Practice Address - Fax:802-496-9874
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0720000083171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications