Healthcare Provider Details

I. General information

NPI: 1346952959
Provider Name (Legal Business Name): MARY LOUISE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 ANDREW CT NW
CORYDON IN
47112-6974
US

IV. Provider business mailing address

1833 ANDREW COURT, NW
CORYDON IN
47112
US

V. Phone/Fax

Practice location:
  • Phone: 831-297-0490
  • Fax: 831-297-0490
Mailing address:
  • Phone: 831-297-0490
  • Fax: 831-297-0490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31006839A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: