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General NPI Number Information
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NPI Number | 1235798265
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Entity Type | Individual
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Provider Name | SARA CAITLYN SMITH
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Gender | Female
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Dates
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Enumeration Date | 06/12/2019
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | 295 N MAIN ST
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City | SPARTA
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State | NC
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Zip | 28675-8895
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Country | US
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Telephone | 336-657-1225
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Fax |
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Provider Business Mailing Address
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Address Line | 590 LOW GAP RD
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City | JEFFERSON
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State | NC
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Zip | 28640-8848
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Country | US
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Telephone | 336-200-1021
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 18181
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License Number State | NC
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