Provider Demographics
NPI:1346509072
Name:SMITH, REBECCA ANN (CMT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11560 W 70TH PL
Mailing Address - Street 2:UNIT D
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-1389
Mailing Address - Country:US
Mailing Address - Phone:580-340-0738
Mailing Address - Fax:
Practice Address - Street 1:11560 W 70TH PL
Practice Address - Street 2:UNIT D
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-1389
Practice Address - Country:US
Practice Address - Phone:580-340-0738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9443174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist