MEDICARE: DENISE T SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1104311562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE T SMITH

Provider Business Mailing Address
First Line	:	2470 FULTON ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43620-1239
Country	:	US
Telephone Number	:	419-250-8301
Fax Number	:

Provider Business Practice Location Address
First Line	:	2470 FULTON ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43620-1239
Country	:	US
Telephone Number	:	419-250-8301
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2018
Last Update Date	:	11/17/2021

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Directions to “ DENISE T SMITH ” Practice Location

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