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General NPI Number Information
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NPI Number | 1932676715
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Entity Type | Individual
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Provider Name | KONAR SMITH
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Gender | Male
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Dates
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Enumeration Date | 10/30/2018
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Last Update Date | 10/30/2018
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Provider Practice Location Address
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Address Line | 34 EDENBRIDGE DRIVE
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City | ANGUS
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State | ONTARIO
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Zip | L0M1B3
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Country | CA
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Telephone | 705-716-5421
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Fax |
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Provider Business Mailing Address
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Address Line | 34 EDENBRIDGE DRIVE
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City | ANGUS
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State | ONTARIO
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Zip | L0M1B3
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Country | CA
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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