Provider Demographics
NPI:1427881838
Name:SMITH, MELISSA A (LMT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 CLAUDE THOMAS RD STE 15
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-2197
Mailing Address - Country:US
Mailing Address - Phone:937-416-7163
Mailing Address - Fax:
Practice Address - Street 1:8401 CLAUDE THOMAS RD STE 15
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-2197
Practice Address - Country:US
Practice Address - Phone:937-416-7163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33015938225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist