Healthcare Provider Details

I. General information

NPI: 1770638751
Provider Name (Legal Business Name): AMY SMALLFIELD MS, ATC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 9TH ST NE
WATERTOWN SD
57201-2863
US

IV. Provider business mailing address

1120 MAYFAIR DR
WATERTOWN SD
57201-1444
US

V. Phone/Fax

Practice location:
  • Phone: 605-881-4264
  • Fax: 605-882-5288
Mailing address:
  • Phone: 605-886-8489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0147
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: