Provider Demographics
NPI:1780287912
Name:SMITH, TERRI W
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:W
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 1:7354 RAMEY RD
Mailing Address - Street 2:
Mailing Address - City:CENTERBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43011-9668
Mailing Address - Country:US
Mailing Address - Phone:740-360-1938
Mailing Address - Fax:740-625-6901
Practice Address - Street 1:7354 RAMEY RD
Practice Address - Street 2:
Practice Address - City:CENTERBURG
Practice Address - State:OH
Practice Address - Zip Code:43011-9668
Practice Address - Country:US
Practice Address - Phone:740-360-1938
Practice Address - Fax:740-625-6901
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2001229Medicaid