Provider Demographics
NPI:1730575457
Name:SMITH, MELISSA GAIL (IECE)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:GAIL
Last Name:SMITH
Suffix:
Gender:F
Credentials:IECE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-8209
Mailing Address - Country:US
Mailing Address - Phone:270-465-1005
Mailing Address - Fax:
Practice Address - Street 1:60 SUNRISE DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-8209
Practice Address - Country:US
Practice Address - Phone:270-465-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist