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NPI Code Detail

MEDICARE: JENNA SMITH

MEDICARE: JENNA SMITH
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
1225X00000XOccupational TherapistCO

General Provider Information

NPI Number : 1508386269
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNA SMITH
Provider Business Mailing Address
First Line : 5030 HERNDON CIR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80920-7050
Country : US
Telephone Number : 719-659-6662
Fax Number :
Provider Business Practice Location Address
First Line : 2365 PATRIOT HTS
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80904-5122
Country : US
Telephone Number : 719-659-6662
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2017
Last Update Date : 06/23/2017

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Directions to “ JENNA SMITH ” Practice Location

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