Matthew Charlew Smitley, DAT, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT-642 Issued in ID

Practice address

875 Perimeter Dr # Ms 2401
Moscow, ID 83844-7462

Phone

(208) 885-0349

Fax

(208) 885-5929

NPI assigned

May 16, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1400198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599004800000",
    "number": "1588075121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 OPAL BROOK DR",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376437462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 PERIMETER DR # MS 2401",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838447462",
            "telephone_number": "208-885-0349",
            "fax_number": "208-885-5929"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "320 Opal Brook Dr",
            "address_purpose": "LOCATION",
            "city": "Elizabethton",
            "state": "TN",
            "postal_code": "376437462",
            "country_code": "US",
            "telephone_number": "805-588-6929",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITLEY",
        "first_name": "MATTHEW",
        "middle_name": "CHARLEW",
        "name_prefix": "Dr.",
        "credential": "DAT, LAT, ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-05-16",
        "last_updated": "2020-09-02",
        "certification_date": "2020-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NC",
            "license": "LAT-2518",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "ID",
            "license": "AT-642",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Faith Smith
• Mashonda Smith, M.S.
• Meredith Smith
• Robert K Smith, CRNA
• Roman Smith
• Hilary Eleanor Snell, DPT
• Tanya Marie Snodgrass
• Judith E. Sobeloff
• Cynthia Soderberg
• Taiyler Jade Soderquist, ATC, NREMT

• Athletic Trainer in Moscow, ID
• Providers in Moscow, ID by specialty
• Athletic Trainer in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.