Provider Demographics
NPI:1417385766
Name:SMALLA, CHRISTY MARIE (BS, LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:MARIE
Last Name:SMALLA
Suffix:
Gender:F
Credentials:BS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1257 WILDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2817
Mailing Address - Country:US
Mailing Address - Phone:517-410-1340
Mailing Address - Fax:419-882-7621
Practice Address - Street 1:6924 SPRING VALLEY DR
Practice Address - Street 2:SUITE 230
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-9482
Practice Address - Country:US
Practice Address - Phone:517-410-1340
Practice Address - Fax:419-882-7621
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.015438225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist