Provider Demographics
NPI:1376060046
Name:SMITH, MORITA ESTELLE (HOME CARE PROVIDER)
Entity Type:Individual
Prefix:
First Name:MORITA
Middle Name:ESTELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:HOME CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4442 W ALEXIS RD STE F
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-1200
Mailing Address - Country:US
Mailing Address - Phone:419-214-1614
Mailing Address - Fax:419-214-9015
Practice Address - Street 1:4442 W ALEXIS RD STE F
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-1200
Practice Address - Country:US
Practice Address - Phone:419-214-1614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01996923747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant