=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114810926
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. ASHLEIGH SMITH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2025
-----------------------------------------------------
Last Update Date | 05/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1301 ROLLING HILLS DR
-----------------------------------------------------
City | MAHOMET
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61853-9454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-553-8261
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4101 LIBERTY BLVD APT 1
-----------------------------------------------------
City | WESTMONT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60559-1348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-426-9386
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 222Q00000X
-----------------------------------------------------
Taxonomy Name | Developmental Therapist
-----------------------------------------------------
License Number | 222Q00000X
-----------------------------------------------------
License Number State |
-----------------------------------------------------