Healthcare Provider Details

I. General information

NPI: 1609941913
Provider Name (Legal Business Name): HULET SMITH JR. O.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 11/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1367 SYDNEYS PASS
WATKINSVILLE GA
30677-8393
US

IV. Provider business mailing address

1367 SYDNEYS PASS
WATKINSVILLE GA
30677-8393
US

V. Phone/Fax

Practice location:
  • Phone: 770-725-9186
  • Fax: 603-843-2144
Mailing address:
  • Phone: 770-725-9186
  • Fax: 603-843-2144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT002264
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: