Provider Demographics
NPI:1386077444
Name:SMITH, DEVON T (MAED, LAT, ATC)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:T
Last Name:SMITH
Suffix:
Gender:M
Credentials:MAED, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9305 S VICKSBURG PARK CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-7751
Mailing Address - Country:US
Mailing Address - Phone:775-354-4243
Mailing Address - Fax:
Practice Address - Street 1:9305 S VICKSBURG PARK CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-7751
Practice Address - Country:US
Practice Address - Phone:775-354-4243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer