Provider Demographics
NPI:1750361994
Name:SMOLA, MARLA KATHLEEN
Entity type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:KATHLEEN
Last Name:SMOLA
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:PO BOX 972
Mailing Address - Street 2:
Mailing Address - City:MILLERS CREEK
Mailing Address - State:NC
Mailing Address - Zip Code:28651-0972
Mailing Address - Country:US
Mailing Address - Phone:336-838-2369
Mailing Address - Fax:336-838-9904
Practice Address - Street 1:1005 PLEASANT HOME CHURCH RD
Practice Address - Street 2:
Practice Address - City:MILLERS CREEK
Practice Address - State:NC
Practice Address - Zip Code:28651-0972
Practice Address - Country:US
Practice Address - Phone:336-838-2369
Practice Address - Fax:336-838-9904
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7701210Medicaid
NC0477JOtherBCBS
6366540001Medicare NSC