Healthcare Provider Details

I. General information

NPI: 1669302782
Provider Name (Legal Business Name): SCOTT SMITH OTR/L
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3036 THOMPSON AVE
SELMA CA
93662-2497
US

IV. Provider business mailing address

2505 W SHAW AVE STE 101
FRESNO CA
93711-3334
US

V. Phone/Fax

Practice location:
  • Phone: 559-898-6500
  • Fax:
Mailing address:
  • Phone: 559-307-3828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number12282
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: