Provider Demographics
NPI:1568591485
Name:SMAHA, MARK JOE (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:JOE
Last Name:SMAHA
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15485 COVE POINT LANE
Mailing Address - Street 2:PO BOX 348
Mailing Address - City:KEYPORT
Mailing Address - State:WA
Mailing Address - Zip Code:98345-0348
Mailing Address - Country:US
Mailing Address - Phone:360-981-2257
Mailing Address - Fax:
Practice Address - Street 1:19611 7TH AVE NE
Practice Address - Street 2:SUITE 20
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7384
Practice Address - Country:US
Practice Address - Phone:360-697-7710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer