Provider Demographics
NPI:1710749791
Name:SMALLEY, MATTISON CLAIRE
Entity Type:Individual
Prefix:
First Name:MATTISON
Middle Name:CLAIRE
Last Name:SMALLEY
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 1:4315 GOLF CLUB DR APT 1303
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-5849
Mailing Address - Country:US
Mailing Address - Phone:256-504-7331
Mailing Address - Fax:
Practice Address - Street 1:4315 GOLF CLUB DR APT 1303
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-5849
Practice Address - Country:US
Practice Address - Phone:256-504-7331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program