Provider Demographics
NPI:1376895011
Name:SMITH, RACHEL E (LAC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 OLEAN RD
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-9744
Mailing Address - Country:US
Mailing Address - Phone:716-652-7551
Mailing Address - Fax:716-805-3373
Practice Address - Street 1:404 OLEAN RD
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-9744
Practice Address - Country:US
Practice Address - Phone:716-652-7551
Practice Address - Fax:716-805-3373
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25004896171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist