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Individual

MRS. ANDREA SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS, ATC/R

Contact information

Practice address
2828 1ST AVE STE 400, HUNTINGTON, WV 25702-1236
(304) 525-6905
(304) 529-6880
Mailing address
2828 1ST AVE STE 400, HUNTINGTON, WV 25702-1236
(304) 525-6905
(304) 529-6880

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000008700
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0010681000
WV
05
352265
OH
Enumeration date
08/31/2015
Last updated
08/31/2015
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