Healthcare Provider Details

I. General information

NPI: 1902564701
Provider Name (Legal Business Name): MS. MICHELLE LEE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5743 MIAMI SHELBY RD
HOUSTON OH
45333-9434
US

IV. Provider business mailing address

636 MARTIN ST
GREENVILLE OH
45331-1829
US

V. Phone/Fax

Practice location:
  • Phone: 937-417-4382
  • Fax:
Mailing address:
  • Phone: 937-417-4382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number0335449
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: