Provider Demographics
NPI:1891992566
Name:SMITH, SHANNON L (LMT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
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Mailing Address - Street 1:9845 GINGER HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEW MIDDLETWN
Mailing Address - State:OH
Mailing Address - Zip Code:44442-8782
Mailing Address - Country:US
Mailing Address - Phone:330-542-3099
Mailing Address - Fax:330-542-3099
Practice Address - Street 1:850 MCKAY CT
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5745
Practice Address - Country:US
Practice Address - Phone:330-726-6339
Practice Address - Fax:330-726-5799
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH33.007877225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist