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Individual
AMANDA NICHOLE SMITH
Active
Individual
AMANDA NICHOLE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC/OTR
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
36001238A
IN
225X00000X
Occupational Therapist
Primary
31005393A
IN
Other
Enumeration date
12/29/2009
Last updated
01/08/2021
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