MEDICARE: MRS. JENNIFER SIMPSON 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
1	225X00000X	Occupational Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0119007005	OTHER	VA	OCCUPATIONAL THERAPIST LICENSE
2	356540	OTHER		NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY

General Provider Information

NPI Number	:	1538532767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER SIMPSON SMITH

Provider Business Mailing Address
First Line	:	320 W MAIN ST
Second Line	:
City	:	COVINGTON
State	:	VA
Zip	:	24426-1517
Country	:	US
Telephone Number	:	540-962-6226
Fax Number	:	409-627-4475

Provider Business Practice Location Address
First Line	:	320 W MAIN ST
Second Line	:
City	:	COVINGTON
State	:	VA
Zip	:	24426-1517
Country	:	US
Telephone Number	:	409-626-2265
Fax Number	:	540-962-7447

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

Provider Enumeration Date	:	11/10/2015
Last Update Date	:	12/15/2022

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