Healthcare Provider Details

I. General information

NPI: 1225629637
Provider Name (Legal Business Name): ASHLEY SMITH LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 W CARPENTER ST STE A
SPRINGFIELD IL
62702-4935
US

IV. Provider business mailing address

1025 S 6TH ST
SPRINGFIELD IL
62703-2403
US

V. Phone/Fax

Practice location:
  • Phone: 309-528-7541
  • Fax: 217-528-6473
Mailing address:
  • Phone: 217-528-7541
  • Fax: 217-525-7616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227021545
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: