Provider Demographics
NPI:1952387565
Name:SMITH, JENNIFER J (MS, AT,C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 BERKSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8818
Mailing Address - Country:US
Mailing Address - Phone:574-527-8667
Mailing Address - Fax:
Practice Address - Street 1:512 E STEPHENS ST
Practice Address - Street 2:MIDWAY COLLEGE
Practice Address - City:MIDWAY
Practice Address - State:KY
Practice Address - Zip Code:40347-1112
Practice Address - Country:US
Practice Address - Phone:859-846-5806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT6012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer