Healthcare Provider Details

I. General information

NPI: 1245075712
Provider Name (Legal Business Name): MICHELLE R SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SHERMAN CIR NE
MASSILLON OH
44646-5219
US

IV. Provider business mailing address

2000 SHERMAN CIR NE
MASSILLON OH
44646-5219
US

V. Phone/Fax

Practice location:
  • Phone: 330-830-9988
  • Fax:
Mailing address:
  • Phone: 330-830-9988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT4943
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: