=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538195771
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID L SMITH MA CCC A
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2006
-----------------------------------------------------
Last Update Date | 02/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5170 US RT 60 EAST
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-528-4600
-----------------------------------------------------
Fax | 304-399-2396
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5170 US RT 60 EAST
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-528-4600
-----------------------------------------------------
Fax | 304-399-2396
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | A0061
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------