Provider Demographics
NPI:1942381553
Name:SMITH, MARLA RENEE (MS, ATC)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:RENEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6707 WAYNE HWY
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-8602
Mailing Address - Country:US
Mailing Address - Phone:717-749-5970
Mailing Address - Fax:
Practice Address - Street 1:550 E 2ND ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268-2352
Practice Address - Country:US
Practice Address - Phone:717-762-1191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART002212A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer