Individual
MRS. KIMBERLY ANN SMITH
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.S. ED, ATC
Contact information
Practice address
5510 E STATE ST, ROCKFORD, IL 61108-2381
(815) 395-4505
(815) 395-4507
Mailing address
165 HARVEST GLENN DR, DAVIS JUNCTION, IL 61020-9797
(815) 645-2439
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
IL
Other
Enumeration date
03/14/2006
Last updated
07/08/2007
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