MEDICARE: CHRISTOPHER J SMITLEY LISW-S

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	1041C0700X	Clinical Social Worker	I0004118	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	I0004118	OTHER	OH	LICENSE

General Provider Information

NPI Number	:	1891035168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER J SMITLEY LISW-S

Provider Business Mailing Address
First Line	:	1526 GRUBB RD
Second Line	:
City	:	CHILLICOTHEE
State	:	OH
Zip	:	45601-8659
Country	:	US
Telephone Number	:	740-773-4261
Fax Number	:

Provider Business Practice Location Address
First Line	:	5310 E MAIN ST
Second Line	:	102
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2598
Country	:	US
Telephone Number	:	614-751-1090
Fax Number	:

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

Provider Enumeration Date	:	02/25/2013
Last Update Date	:	02/25/2013

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