Healthcare Provider Details

I. General information

NPI: 1013549377
Provider Name (Legal Business Name): DAIJONNAI SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WEST HOSPITAL DRIVE
WHITERIVER AZ
85941
US

IV. Provider business mailing address

200 WEST HOSPITAL DRIVE
WHITERIVER AZ
85941
US

V. Phone/Fax

Practice location:
  • Phone: 928-338-4911
  • Fax:
Mailing address:
  • Phone: 928-338-4911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17430
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: