Healthcare Provider Details

I. General information

NPI: 1194073189
Provider Name (Legal Business Name): AMY LYNNE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2012
Last Update Date: 08/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6570 GLENWAY AVE
CINCINNATI OH
45211-4410
US

IV. Provider business mailing address

6570 GLENWAY AVE
CINCINNATI OH
45211-4410
US

V. Phone/Fax

Practice location:
  • Phone: 513-598-9444
  • Fax: 513-598-8223
Mailing address:
  • Phone: 513-598-9444
  • Fax: 513-598-8223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2953
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: