=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902347412
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHELSEA LAUREN SMISEK HAMNER ITDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2017
-----------------------------------------------------
Last Update Date | 02/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1757 INDIANA AVE
-----------------------------------------------------
City | WINTER PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32789-5446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-506-6705
-----------------------------------------------------
Fax | 407-988-1514
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1757 INDIANA AVE
-----------------------------------------------------
City | WINTER PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32789-5446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-506-6705
-----------------------------------------------------
Fax | 352-241-6361
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 222Q00000X
-----------------------------------------------------
Taxonomy Name | Developmental Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------