=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649153669
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. FELICIA PAULETTE SMITH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2025
-----------------------------------------------------
Last Update Date | 07/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 MARKET AVE N
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44702-1083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 234-214-0469
-----------------------------------------------------
Fax | 877-569-6002
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 265 N THOMAS RD APT 217A
-----------------------------------------------------
City | TALLMADGE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44278-1767
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-400-1256
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------