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General NPI Number Information
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NPI Number | 1871812966
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Entity Type | Organization
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Legal Business Name | SMITH PEDIATRIC REHAB, LLC
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Dates
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Enumeration Date | 05/27/2010
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Last Update Date | 05/27/2010
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Provider Practice Location Address
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Address Line | 137 WHITMAN RD
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City | MUNFORDVILLE
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State | KY
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Zip | 42765-8228
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Country | US
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Telephone | 270-202-1825
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Fax | 270-524-1269
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Provider Business Mailing Address
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Address Line | 137 WHITMAN RD
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City | MUNFORDVILLE
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State | KY
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Zip | 42765-8228
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Country | US
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Telephone | 270-202-1825
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Fax | 270-524-1269
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST/OWNER
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Name | LESSA SMITH CROLEY
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Credential | MSCCCSLP
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Telephone | 270-202-1825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2115
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License Number State | KY
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