MEDICARE: BRANDI LEE SMITHSON MS, 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	OT 13022	FL

General Provider Information

NPI Number	:	1568630507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI LEE SMITHSON MS, OTR/L

Provider Business Mailing Address
First Line	:	2401 NE 65TH ST
Second Line	:	APT 102
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-1552
Country	:	US
Telephone Number	:	954-459-5644
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 NE 65TH ST
Second Line	:	APT 102
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-1552
Country	:	US
Telephone Number	:	954-459-5644
Fax Number	:

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

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	09/28/2009

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