Provider Demographics
NPI:1174341762
Name:SMITLEY, DERRICK
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:
Last Name:SMITLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6137 COLUMBIA RD NW
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-7674
Mailing Address - Country:US
Mailing Address - Phone:330-243-9015
Mailing Address - Fax:
Practice Address - Street 1:6137 COLUMBIA RD NW
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-7674
Practice Address - Country:US
Practice Address - Phone:330-243-9015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care