Provider Demographics
NPI:1689382095
Name:SMITH, CATERRA LYNE
Entity type:Individual
Prefix:
First Name:CATERRA
Middle Name:LYNE
Last Name:SMITH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3829 WOODLEY RD STE B6
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1174
Mailing Address - Country:US
Mailing Address - Phone:419-690-4544
Mailing Address - Fax:
Practice Address - Street 1:3829 WOODLEY RD STE B6
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1174
Practice Address - Country:US
Practice Address - Phone:419-690-4544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X, 376J00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No376J00000XNursing Service Related ProvidersHomemaker