Healthcare Provider Details

I. General information

NPI: 1033960125
Provider Name (Legal Business Name): MARISA SMET MS, ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W SEWARD ST
RIPON WI
54971-1465
US

IV. Provider business mailing address

473 AUSTIN LN
FOND DU LAC WI
54935-5483
US

V. Phone/Fax

Practice location:
  • Phone: 920-748-8115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number3297-39
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: