Healthcare Provider Details

I. General information

NPI: 1508783887
Provider Name (Legal Business Name): ALISHA KRISTY SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E DAVID RD STE 103
KETTERING OH
45429-5741
US

IV. Provider business mailing address

1201 E DAVID RD STE 103
KETTERING OH
45429-5741
US

V. Phone/Fax

Practice location:
  • Phone: 937-234-7016
  • Fax:
Mailing address:
  • Phone: 937-234-7016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33027170
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: