Provider Demographics
NPI:1811786320
Name:SMITH, CARLY (HAS-T)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:HAS-T
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:VACCARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2578 DAGGETT AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1127
Mailing Address - Country:US
Mailing Address - Phone:541-884-4000
Mailing Address - Fax:
Practice Address - Street 1:2578 DAGGETT AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1127
Practice Address - Country:US
Practice Address - Phone:541-884-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-T-10252675237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist