MEDICARE: FELICIA DAWN SMITH

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
1	225200000X	Physical Therapy Assistant	2306602966	VA
2	225200000X	Physical Therapy Assistant	PTA.07679	OH

General Provider Information

NPI Number	:	1639462559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELICIA DAWN SMITH

Provider Business Mailing Address
First Line	:	128 DAWES CIR
Second Line	:
City	:	MARIETTA
State	:	OH
Zip	:	45750-1516
Country	:	US
Telephone Number	:	740-525-4090
Fax Number	:

Provider Business Practice Location Address
First Line	:	128 DAWES CIR
Second Line	:
City	:	MARIETTA
State	:	OH
Zip	:	45750-1516
Country	:	US
Telephone Number	:	740-525-4090
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2011
Last Update Date	:	02/14/2012

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Directions to “ FELICIA DAWN SMITH ” Practice Location

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