Provider Demographics
NPI:1568400422
Name:SMITH, DIANE K (LPT)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:K
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2452
Mailing Address - Country:US
Mailing Address - Phone:740-851-4432
Mailing Address - Fax:740-851-4712
Practice Address - Street 1:111 W WATER ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2452
Practice Address - Country:US
Practice Address - Phone:740-851-4432
Practice Address - Fax:740-851-4712
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6591225100000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1568400422Medicaid