Provider Demographics
NPI:1780871616
Name:SMITH, AMBER LYNN (MA, PC, ATR)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, PC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 MOUNT PLEASANT ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721-1454
Mailing Address - Country:US
Mailing Address - Phone:330-244-0327
Mailing Address - Fax:
Practice Address - Street 1:2414 MOUNT PLEASANT ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44721-1454
Practice Address - Country:US
Practice Address - Phone:330-244-0327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist