Individual
ELISSA SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
745 CAMPBELLSVILLE ST, LIBERTY, KY 42539-3107
(606) 706-0304
Mailing address
PO BOX 776, LIBERTY, KY 42539-0776
(606) 787-6337
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
KY-R3448
KY
Other
Enumeration date
09/14/2007
Last updated
09/14/2007
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