Provider Demographics
NPI:1295423986
Name:SMITH, ERICA THERESA
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:THERESA
Last Name:SMITH
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 1:4379 E 131ST ST
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44105-6945
Mailing Address - Country:US
Mailing Address - Phone:216-816-4548
Mailing Address - Fax:
Practice Address - Street 1:4379 E 131ST ST
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44105-6945
Practice Address - Country:US
Practice Address - Phone:216-816-4548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver