Provider Demographics
NPI:1588209787
Name:SMITH, MAUREEN P
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:P
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23700 SAMUEL ADAMS CIR
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-8225
Mailing Address - Country:US
Mailing Address - Phone:860-307-7373
Mailing Address - Fax:
Practice Address - Street 1:23700 SAMUEL ADAMS CIR
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-8225
Practice Address - Country:US
Practice Address - Phone:860-307-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer