Healthcare Provider Details

I. General information

NPI: 1659123032
Provider Name (Legal Business Name): THERESA M. SMILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THERESA SMILEY THERESA SMILEY QMHS

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 BLACKLICK EASTERN RD
PICKERINGTON OH
43147-8235
US

IV. Provider business mailing address

9209 GRAND DIVISION AVE # 9
CLEVELAND OH
44125-1353
US

V. Phone/Fax

Practice location:
  • Phone: 440-538-4564
  • Fax:
Mailing address:
  • Phone: 440-538-4564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: