Healthcare Provider Details

I. General information

NPI: 1588474183
Provider Name (Legal Business Name): MAGGIE C SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2956 LEXINGTON RD
RICHMOND KY
40475-9141
US

IV. Provider business mailing address

1023 HARBOUR LN
LAWRENCEBURG KY
40342-8544
US

V. Phone/Fax

Practice location:
  • Phone: 859-537-5367
  • Fax:
Mailing address:
  • Phone: 859-948-1492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: