Provider Demographics
NPI:1962833459
Name:SMITH, PEYTON DIAHNN (LMT (LICENSED MASSAG)
Entity Type:Individual
Prefix:MRS
First Name:PEYTON
Middle Name:DIAHNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT (LICENSED MASSAG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1087
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45802-1087
Mailing Address - Country:US
Mailing Address - Phone:419-233-4827
Mailing Address - Fax:
Practice Address - Street 1:2345 W ELM ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2540
Practice Address - Country:US
Practice Address - Phone:419-233-4827
Practice Address - Fax:567-940-5464
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.012230225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist