Healthcare Provider Details

I. General information

NPI: 1427978576
Provider Name (Legal Business Name): KRISTEN ELIZABETH SMIALEK LMT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4781 KEARNEYSVILLE PIKE
SHEPHERDSTOWN WV
25443-4666
US

IV. Provider business mailing address

800 SUMMERCHASE ST APT 203
CHARLES TOWN WV
25414-6111
US

V. Phone/Fax

Practice location:
  • Phone: 304-620-4786
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2025-4201
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: