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General NPI Number Information
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NPI Number | 1366484537
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Entity Type | Individual
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Provider Name | DANNY E. SMILEY JR. LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 720 W CENTRAL AVE
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City | EL DORADO
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State | KS
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Zip | 67042-2112
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Country | US
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Telephone | 316-322-4580
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Fax |
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Provider Business Mailing Address
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Address Line | 2816 DANBURY RD
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City | AUGUSTA
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State | KS
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Zip | 67010-2289
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Country | US
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Telephone | 316-775-2447
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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 | 24-00208
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License Number State | KS
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