MEDICARE: JENNIFER NICOLE SMITH OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OC017657	PA
2	225XH1200X	Hand Occupational Therapist	OC017657	PA

General Provider Information

NPI Number	:	1104496751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER NICOLE SMITH OTR/L

Provider Business Mailing Address
First Line	:	PO BOX 34990
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-0627
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 W CHESTER PIKE STE 425
Second Line	:
City	:	HAVERTOWN
State	:	PA
Zip	:	19083-2740
Country	:	US
Telephone Number	:	610-789-9815
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2021
Last Update Date	:	06/24/2024

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