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General NPI Number Information
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NPI Number | 1164837357
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Entity Type | Individual
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Provider Name | MISS PAULA TIFFANY NICOLE SMALLWOOD
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Gender | Female
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Dates
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Enumeration Date | 06/25/2014
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Last Update Date | 09/21/2022
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Provider Practice Location Address
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Address Line | 109 HILLVIEW DR
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City | LEITCHFIELD
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State | KY
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Zip | 42754-1807
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Country | US
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Telephone | 270-899-0175
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Fax |
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Provider Business Mailing Address
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Address Line | 109 HILLVIEW DR
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City | LEITCHFIELD
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State | KY
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Zip | 42754-1807
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Country | US
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Telephone | 270-899-0175
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Fax | 844-688-4227
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number | 201154945
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License Number State | KY
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