Healthcare Provider Details

I. General information

NPI: 1821116674
Provider Name (Legal Business Name): DONNA SMITH OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 03/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 KINDERHOOK ST
VALATIE NY
12184-9306
US

IV. Provider business mailing address

1050 KINDERHOOK ST PO BOX 142
VALATIE NY
12184-9306
US

V. Phone/Fax

Practice location:
  • Phone: 518-469-3108
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number012507
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: