Provider Demographics
NPI:1487688354
Name:SMITH, JOLYNN R (PTA/ATC)
Entity Type:Individual
Prefix:
First Name:JOLYNN
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:PTA/ATC
Other - Prefix:
Other - First Name:JOLYNN
Other - Middle Name:
Other - Last Name:OHLDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA/ATC
Mailing Address - Street 1:6405 METCALF AVE
Mailing Address - Street 2:STE. 220
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66202-3931
Mailing Address - Country:US
Mailing Address - Phone:913-871-2721
Mailing Address - Fax:
Practice Address - Street 1:6405 METCALF AVE
Practice Address - Street 2:STE. 220
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66202-3931
Practice Address - Country:US
Practice Address - Phone:913-871-2721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-0550225200000X
MO2002009370225200000X
KS24-004482255A2300X
MO20050177822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer