1467665570 NPI number — MRS. EMILY JANE SMITH OTR/L, MOT

Table of content: MRS. EMILY JANE SMITH OTR/L, MOT (NPI 1467665570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467665570 NPI number — MRS. EMILY JANE SMITH OTR/L, MOT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
EMILY
Provider Middle Name:
JANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L, MOT
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:
1467665570
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
167 HIGHLANDER DR NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKFORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49341-8297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-739-0399
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 STATE RD STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWAYGO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49337-7982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-968-1331
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2007

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:  OT.007437 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: 5201010068 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2542118 . This is a "INDEPENDENT PROVIDER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 266345 . This is a "NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: OT. 007437 . This is a "OHIO OCCUPATIONAL THERAPY, PHYSICAL THERAPY, AND ATHLETIC TRAINERS BOARD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 5201010068 . This is a "MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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