Provider Demographics
NPI:1477899185
Name:SMITH, STEPHEN JAVOIL II
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JAVOIL
Last Name:SMITH
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 ASPEN PEAK LOOP
Mailing Address - Street 2:APT# 1622
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-1803
Mailing Address - Country:US
Mailing Address - Phone:702-420-9625
Mailing Address - Fax:
Practice Address - Street 1:833 ASPEN PEAK LOOP
Practice Address - Street 2:APT# 1622
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-1803
Practice Address - Country:US
Practice Address - Phone:702-420-9625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner