Olivia Carmen Smith, ATC

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

License

0506532 Issued in NV

Practice address

2439 Country Club Dr
Glendora, CA 91741-4009

Phone

(949) 525-7601

NPI assigned

Oct 1, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

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": "1569888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569888000000",
    "number": "1841831864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2439 COUNTRY CLUB DR",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917414009",
            "telephone_number": "949-525-7601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2439 COUNTRY CLUB DR",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917414009",
            "telephone_number": "949-525-7601"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1537 Stanford St Apt 1",
            "address_purpose": "LOCATION",
            "city": "Santa Monica",
            "state": "CA",
            "postal_code": "904043636",
            "country_code": "US",
            "telephone_number": "949-525-7601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "OLIVIA",
        "middle_name": "CARMEN",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-01",
        "last_updated": "2019-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "NV",
            "license": "0506532",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEVADA STATE BOARD OF ATHLETIC TRAINERS",
            "identifier": "0506532",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATA/BOC",
            "identifier": "2000025843",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "olivia@gamedaytrainers.com",
            "affiliation": "N",
            "endpointDescription": "share patient information with parents and other athletic trainers",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "2439 Country Club Dr",
            "city": "Glendora",
            "state": "CA",
            "country_code": "US",
            "postal_code": "917414009",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Samantha Sison Gonzalez
• Danielle Sivixay, RN
• James F. Skalicky, PH.D.
• Natalia Slusky, DDS
• Anneka Smith
• Chad Andrew Snowball I
• Adam Jonathan Snyder, M.D.
• Shawky Antonios Younan Soliman, DDS
• Oliver M Solomon, DO
• Somnus Sleep Laboratory, Inc.

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Glendora, CA
• Providers in Glendora, CA by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2019; 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.