Provider Demographics
NPI:1598154932
Name:SMITH, JENNIFER
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:
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 1:5919 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:44216-9427
Mailing Address - Country:US
Mailing Address - Phone:330-606-7258
Mailing Address - Fax:
Practice Address - Street 1:5919 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OH
Practice Address - Zip Code:44216-9427
Practice Address - Country:US
Practice Address - Phone:330-606-7258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0044762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer