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General NPI Number Information
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NPI Number | 1184164782
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Entity Type | Individual
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Provider Name | SHELBY LYNN SMITH LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 03/01/2017
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 6035 RADIO STATION RD
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City | LA PLATA
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State | MD
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Zip | 20646-3369
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Country | US
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Telephone | 301-848-3199
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Fax |
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Provider Business Mailing Address
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Address Line | 7400 BRENTLAND RD
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City | WELCOME
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State | MD
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Zip | 20693-3407
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Country | US
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Telephone | 301-848-3199
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | A00910
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License Number State | MD
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