Healthcare Provider Details

I. General information

NPI: 1053227587
Provider Name (Legal Business Name): AUTUMN DESRI SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 WOLF LEDGES PKWY STE 410
AKRON OH
44311-1054
US

IV. Provider business mailing address

1900 NEWTON ST APT J
AKRON OH
44305-3069
US

V. Phone/Fax

Practice location:
  • Phone: 330-298-8661
  • Fax:
Mailing address:
  • Phone: 330-802-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: