Provider Demographics
NPI:1548679798
Name:SMITH, CALLI MARIE (LMT)
Entity type:Individual
Prefix:
First Name:CALLI
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CALLI
Other - Middle Name:MARIE
Other - Last Name:SHERL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:404 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-2712
Mailing Address - Country:US
Mailing Address - Phone:618-997-8066
Mailing Address - Fax:618-997-7702
Practice Address - Street 1:404 S COURT ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-2712
Practice Address - Country:US
Practice Address - Phone:618-997-8066
Practice Address - Fax:618-997-7702
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.013532225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist