Individual
STACEY RENEE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
309 E MOREHEAD ST, SUITE 200, CHARLOTTE, NC 28202-2301
(800) 299-8132
Mailing address
16225 TIMBERMAN RD NW, MALTA, OH 43758-9132
(740) 704-6584
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
04582
OH
Other
Enumeration date
12/02/2011
Last updated
12/02/2011
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