Healthcare Provider Details

I. General information

NPI: 1881687234
Provider Name (Legal Business Name): JASON REID SMEENK ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 UPPER COLLEGE DR ORVIS ACTIVITIES CENTER
ALFRED NY
14802-1137
US

IV. Provider business mailing address

10 UPPER COLLEGE DR ORVIS ACTIVITIES CENTER
ALFRED NY
14802-1137
US

V. Phone/Fax

Practice location:
  • Phone: 607-587-4359
  • Fax: 607-587-4331
Mailing address:
  • Phone: 607-587-4359
  • Fax: 607-587-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: