Individual
AMANDA NICHOLE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC/OTR
Contact information
Practice address
11143 PARKVIEW PLAZA DR STE 100, FORT WAYNE, IN 46845-1728
(260) 266-7400
(260) 266-7439
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
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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