1013900968 NPI number — BRENDA FLORY SMILEY OTR/L

Table of content: BRENDA FLORY SMILEY OTR/L (NPI 1013900968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013900968 NPI number — BRENDA FLORY SMILEY OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMILEY
Provider First Name:
BRENDA
Provider Middle Name:
FLORY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013900968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 468
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23901-0468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-392-4910
Provider Business Mailing Address Fax Number:
434-392-8793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1412 W 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23901-2648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-392-1596
Provider Business Practice Location Address Fax Number:
434-392-5201
Provider Enumeration Date:
08/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  0119002641 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 23591 . This is a "CARE NET" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 280506 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 227310 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 14190 . This is a "OPTIMA HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 65549 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 21148 . This is a "UNICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7948175 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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