Healthcare Provider Details

I. General information

NPI: 1235173634
Provider Name (Legal Business Name): MRS. JOANN MARIA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: JOANN MARIA KULWAY M.A.

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 W AURORA RD
NORTHFIELD OH
44067-2003
US

IV. Provider business mailing address

61 W AURORA RD
NORTHFIELD OH
44067-2003
US

V. Phone/Fax

Practice location:
  • Phone: 330-467-4130
  • Fax: 330-467-4131
Mailing address:
  • Phone: 330-467-4130
  • Fax: 330-467-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA00343
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: