Healthcare Provider Details

I. General information

NPI: 1386792489
Provider Name (Legal Business Name): FREIDA SMITH POAG OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2557 PEMBROKE RD
GASTONIA NC
28054-4712
US

IV. Provider business mailing address

2557 PEMBROKE RD
GASTONIA NC
28054-4712
US

V. Phone/Fax

Practice location:
  • Phone: 704-747-3788
  • Fax:
Mailing address:
  • Phone: 980-320-8275
  • Fax: 704-973-7862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3364
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number3364
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: