Individual
MICAH SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
7325 SW CHILDS RD, PORTLAND, OR 97224-7713
(317) 504-0593
Mailing address
411 W HAWKINS PKWY, APT 4301, LONGVIEW, TX 75605-1723
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
10226142
OR
Other
Enumeration date
11/02/2016
Last updated
04/19/2024
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