Healthcare Provider Details

I. General information

NPI: 1992611214
Provider Name (Legal Business Name): JACQUELINE LOUISA MEYERS SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 ROUND HILL CLUB RD
GREENWICH CT
06831-3398
US

IV. Provider business mailing address

26 MAPLEWOOD PL
STAMFORD CT
06905-1808
US

V. Phone/Fax

Practice location:
  • Phone: 203-869-2350
  • Fax:
Mailing address:
  • Phone: 914-261-1436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number001680
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: