Healthcare Provider Details

I. General information

NPI: 1467665570
Provider Name (Legal Business Name): EMILY JANE SMITH OTR/L, MOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 STATE RD STE 3
NEWAYGO MI
49337-7982
US

IV. Provider business mailing address

167 HIGHLANDER DR NE
ROCKFORD MI
49341-8297
US

V. Phone/Fax

Practice location:
  • Phone: 800-968-1331
  • Fax:
Mailing address:
  • Phone: 513-739-0399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT.007437
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201010068
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: