Provider Demographics
NPI:1215374319
Name:MONEYSMITH, KURT
Entity Type:Individual
Prefix:MR
First Name:KURT
Middle Name:
Last Name:MONEYSMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13608 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45390-9603
Mailing Address - Country:US
Mailing Address - Phone:937-621-2275
Mailing Address - Fax:
Practice Address - Street 1:13608 WILSON RD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:OH
Practice Address - Zip Code:45390-9603
Practice Address - Country:US
Practice Address - Phone:937-621-2275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH.0035542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer