Provider Demographics
NPI:1720590532
Name:SMITH, ALLISON (MS, SCAT, ATC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, SCAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:NEW HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43145-9725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 W FRONT ST
Practice Address - Street 2:
Practice Address - City:NEW HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43145-9725
Practice Address - Country:US
Practice Address - Phone:740-255-1323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0044632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer