Provider Demographics
NPI:1285022038
Name:SMITH, DILLON EDWARD (MS, SCAT, ATC, PES)
Entity Type:Individual
Prefix:
First Name:DILLON
Middle Name:EDWARD
Last Name:SMITH
Suffix:
Gender:M
Credentials:MS, SCAT, ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 GLEN RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8494
Mailing Address - Country:US
Mailing Address - Phone:706-373-4635
Mailing Address - Fax:
Practice Address - Street 1:425 JACK BRANCH DR
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28608-0001
Practice Address - Country:US
Practice Address - Phone:706-373-4635
Practice Address - Fax:828-262-7099
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-02
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer