Healthcare Provider Details

I. General information

NPI: 1831739663
Provider Name (Legal Business Name): NATASHA MARIE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 JACKSON PIKE
GALLIPOLIS OH
45631-2600
US

IV. Provider business mailing address

18 QUAIL CREEK EXT LOT 33
GALLIPOLIS OH
45631-8404
US

V. Phone/Fax

Practice location:
  • Phone: 740-645-7549
  • Fax:
Mailing address:
  • Phone: 740-441-5961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: