Provider Demographics
NPI:1871113282
Name:SMITH, HANNAH HERGOTT (LMBT)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:HERGOTT
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 CROWN DR UNIT 103
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8623
Mailing Address - Country:US
Mailing Address - Phone:704-726-0317
Mailing Address - Fax:
Practice Address - Street 1:437 CROWN DR UNIT 103
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8623
Practice Address - Country:US
Practice Address - Phone:704-726-0317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-26
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18159225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist