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NPI Code Detail

MEDICARE: KELSEY MARIE SMITH LMT

MEDICARE: KELSEY MARIE SMITH LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist33.024250OH

General Provider Information

NPI Number : 1114536190
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY MARIE SMITH LMT
Provider Business Mailing Address
First Line : 209 BROOKWOOD DR
Second Line :
City : ENGLEWOOD
State : OH
Zip : 45322-2461
Country : US
Telephone Number : 937-972-3062
Fax Number :
Provider Business Practice Location Address
First Line : 5 N MAIN ST
Second Line :
City : ENGLEWOOD
State : OH
Zip : 45322-1326
Country : US
Telephone Number : 937-890-8660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2020
Last Update Date : 07/27/2020

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Directions to “ KELSEY MARIE SMITH LMT” Practice Location

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