Healthcare Provider Details

I. General information

NPI: 1275654550
Provider Name (Legal Business Name): JENNIFER SMITH OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 COVERT PL
FORT THOMAS KY
41075-1075
US

IV. Provider business mailing address

61 COVERT PL
FORT THOMAS KY
41075-1075
US

V. Phone/Fax

Practice location:
  • Phone: 251-689-4482
  • Fax: 859-757-2490
Mailing address:
  • Phone: 251-689-4482
  • Fax: 859-757-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberKYR2560
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: