=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760197388
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MADELINE SMEATON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2023
-----------------------------------------------------
Last Update Date | 01/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 621 DEXTER ST
-----------------------------------------------------
City | CENTRAL FALLS
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02863-2742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-808-5484
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39 MELISSA ST
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02909-5136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-975-3685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SP00852-P
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SP00582-P
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------